UNITED STATES OF AMERICA 

BEFORE FEDERAL TRADE COMMISSION 

COMMISIONERS: Joseph J. Simons, Chairman 

Noah Joshua Phillips 

Rohit Chopra 

Rebecca Kelly Slaughter 

Christine S. Wilson 

File No. P215800 

ORDER TO FILE SPECIAL REPORT 

Pursuant to a resolution of the Federal Trade Commission (“FTC” or “Commission”) dated 

January 13, 2021, entitled “Resolution Directing Use of Compulsory Process to Collect 

Information Regarding Physician Group and Healthcare Facility Mergers” a copy of which is 

enclosed, [COMPANY NAME], hereinafter referred to as “the Company,” is ordered to file a 

Special Report with the Commission no later than April 20, 2021, containing the information 

specified herein. 

The information provided in the Special Report will assist the Commission in studying the 

competitive impact of physician and healthcare facility consolidation in markets for healthcare 

services. 

The information requests to which you must respond are set forth in the attached 

Specifications. The Special Report must restate each item of this Order with which the 

corresponding answer is identified. Your Special Report is required to be subscribed and sworn 

by an official of the Company who has prepared or supervised the preparation of the Special 

Report from books, records, documents, correspondence, and other data and material in the 

Company’s possession. If the Company cannot answer any question fully, give the information 

that is available and explain in what respects and why the answer is incomplete. 

You are required to respond to this Order using information in your possession, custody, or 

control, including information maintained in a central data repository to which you have access. 

You should not seek any responsive information and data from separately incorporated 

subsidiaries or affiliates or from individuals (other than in their capacity as your employee or as 

your agent). However, you should provide information from separately incorporated subsidiaries 

or affiliates or from individuals if you already have possession, custody, or control of such 

information. 

Confidential or privileged commercial or financial information will be reported by the 

Commission on an aggregate or anonymous basis, consistent with sections 6(f) and 21(d) of the 

FTC Act. Individual submissions to this Order that are marked “confidential” will not be 

disclosed without first giving the Company ten (10) days’ notice of the Commission’s intention 

to do so, except as provided in Sections 6(f) and 21(d) of the FTC Act, 15 U.S.C. §§ 46(f) and 
 _________________________ 

57b-2. This Order does not require approval of the Office of Management and Budget under the 

Paperwork Reduction Act of 1995. 

Penalties may be imposed under applicable provisions of federal law for failure to file 

Special Reports or for the filing of false reports. 

By direction of the Commission. 

Joseph J. Simons 

Chairman 

SEAL 

Date of Order: January 13, 2021 

Any inquiry concerning the Report required by this Order should be addressed to: 

Stephanie A. Wilkinson 

Federal Trade Commission 

Office of Policy Planning 

600 Pennsylvania Avenue, N.W., Mailstop H-394 

Washington, D.C. 20580 

Direct Dial: (202) 326-2084 

Email: swilkinson@ftc.gov 
 

 

 

 

 

SPECIFICATIONS 

1. Submit (in electronic, machine readable format directly to the Commission 

representative(s) identified in Instruction I11), for each patient that is a member of a 

health plan provided or administered by the Company in the Relevant Area (regardless of 

whether the patient received any of the services identified in Specifications 2-4), for each 

calendar year during the period January 1, 2015 to the present: 

(a) A unique patient identifier, different from that of other patients and the same as 

that for different inpatient admissions, Outpatient Episodes, and Practitioner 

Treatment Episodes for the same patient (to protect patient privacy, the Company 

shall mask personal identifying information, such as the patient’s name or Social 

Security number, pursuant to Instruction I3); 

(b) The patient’s county of residence and the patient’s 5-digit ZIP code of residence; 

(c) The patient’s gender, age (including age in days if the patient is less than one year 

old), race, and ethnicity; 

(d) The specific name and type (e.g., HMO, POS, PPO, etc.) of the Health Plan 

product – including the name of the sponsor or patient employer for Self-Insured 

Health Plans – corresponding to the patient; 

(e) Whether the patient obtained the Health Plan product through an employer, a 

private exchange, or a public exchange; 

(f) The total billed charges of all health providers (including those providing services 

identified in Specifications 2-4 and providers providing services other than those 

specified in Specifications 2-4), the allowed amount under the patient’s Health 

Plan, the amount actually paid by the Health Plan, and whether the amount 

actually paid by the Health Plan includes any adjustments under any stop-loss 

provisions; 

(g) Any additional amounts paid or to be paid by the patient to the providers 

(including those providing services identified in Specifications 2-4 and providers 

providing services other than those specified in Specifications 2-4) under the 

patient’s Health Plan, including (and listed separately): 

(i) Total Deductibles paid by the patient; 

(ii) Total Copays paid by the patient; and 

(iii) The total Coinsurance amount paid by the patient. 

2. Submit (in electronic, machine readable format directly to the Commission 

representative(s) identified in Instruction I11), for each inpatient admission that occurred 

in the period January 1, 2015 to the present, and that involved a patient residing in the 

Relevant Area (regardless of the location of the Hospital accessed by the patient) or a 
 

 

 

 

 

 

 

 

 

Order to File Special Report (COMPANY NAME) 

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patient accessing a Hospital in the Relevant Area (regardless of the patient’s place of 

residence): 

(a) A unique patient identifier, different from that of other patients and the same as 

that for different inpatient admissions, Outpatient Episodes, and Practitioner 

Treatment Episodes for the same patient (to protect patient privacy, the Company 

shall mask personal identifying information, such as the patient’s name or Social 

Security number, pursuant to Instruction I3); and, if the Company is providing 

data in multiple records for the inpatient admission, a unique inpatient admission 

identifier that shall also be included in each record associated with the same 

admission (to protect patient privacy, the Company shall mask personal 

identifying information, such as the patient’s name or Social Security number, 

pursuant to Instruction I3); 

(b) The identity of the Hospital at which the patient received the inpatient care, 

including the identity of the Hospital’s owner, the address of the Hospital 

(including the ZIP code), and any Hospital identification number used for 

reimbursement purposes, including Medicare Provider ID or National Provider 

Identification (“NPI”) number; 

(c) The patient’s county of residence and the patient’s 5-digit ZIP code of residence; 

(d) The patient’s gender, age (including age in days if the patient is less than one year 

old), race, and ethnicity; 

(e) The date of admission and date of discharge; 

(f) The Diagnosis Related Group (“DRG” or “MSDRG”) and the Major Diagnostic 

Category (“MDC”) associated with the patient’s admission; 

(g) The primary ICD9 or ICD10 diagnosis code and any secondary ICD9 or ICD10 

diagnosis code(s) associated with the patient’s admission; 

(h) The primary ICD9 or ICD10 procedure code and any secondary ICD9 or ICD10 

procedure code(s) associated with the patient’s admission; 

(i) Whether the Treatment provided was for an emergency; 

(j) The source of the patient (e.g., transfer or referral from another Provider), 

including the identity of any transferring or referring Provider; 

(k) The specific name and type (e.g., HMO, POS, PPO, etc.) of the Health Plan 

product – including the name of the sponsor or patient employer for Self-Insured 

Health Plans – that was the principal source of payment; 

(l) Whether the patient obtained the Health Plan product through an employer, a 

private exchange, or a public exchange; 
 

 

 

 

 

 

 

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(m) The identity of any secondary sources of payment; 

(n) For each product listed in response to Specification 2(k), whether this product was 

offered through a managed care contract with Medicare, Medicaid, or other public 

health insurance program; 

(o) Whether the Hospital identified in response to Specification 2(b) was a 

participating Provider under the patient’s Health Plan and, if the patient’s Health 

Plan had different Tiers of participating Providers, which Tier the Hospital was 

in; 

(p) The billed charges of the Hospital, the allowed amount under the patient’s Health 

Plan, the amount actually paid by the Health Plan, and whether the amount 

actually paid by the Health Plan includes any adjustments under any stop-loss 

provisions; 

(q) Whether the physician’s services were included in the bill or were billed 

separately; 

(r) Any additional amounts paid or to be paid by the patient to the Hospital under the 

patient’s Health Plan (broken out by any codes and modifiers used for billing), 

including (and listed separately): 

(i) The Deductible amount; 

(ii) The Copay amount; and 

(iii) The Coinsurance amount; 

(s) Whether the allowed amount identified in response to Specification 2(p) was 

determined under a coordination-of-benefits arrangement, and if it was: 

(i) whether the Company was the designated primary payor under this 

arrangement; and 

(ii) what the allowed amount would have been absent the coordination-ofbenefits arrangement; 

(t) Any breakdown of the billed charges identified in response to Specification 2(p) 

by any categories of Hospital services rendered to the patient (e.g., 

medical/surgical, obstetrics, pediatrics, ICU); 

(u) Any breakdown of the allowed amount identified in response to Specification 2(p) 

by any categories of Hospital services rendered to the patient (e.g., 

medical/surgical, obstetrics, pediatrics, ICU); 

(v) The type of admission (e.g., newborn, admitted through emergency room, 

admitted through physician referral); 
 

 

 

 

 

 

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(w) The name, NPI number, employer or Physician Group (including NPI number), 

and specialty area of practice of each admitting, treating, and referring physician; 

and 

(x) The patient’s status (e.g., normal discharge, deceased, transferred to another 

Hospital) upon discharge. If the patient was transferred to another Healthcare 

Facility, identify the Healthcare Facility, including the address of the Healthcare 

Facility (including the ZIP code), any Hospital identification number, and the 

reason for the transfer. 

3. Submit (in electronic, machine readable format directly to the Commission representative 

identified in Instruction I11), for each Outpatient Episode that occurred in the period 

January 1, 2015 to the present, and that involved a patient residing in the Relevant Area 

(regardless of the location of the Healthcare Facility accessed by the patient) or a patient 

accessing a Healthcare Facility in the Relevant Area (regardless of the patient’s place of 

residence): 

(a) A unique patient identifier, different from that of other patients and the same as 

that for different inpatient admissions, Outpatient Episodes, and Practitioner 

Treatment Episodes, for the same patient (to protect patient privacy, the Company 

shall mask personal identifying information, such as the patient’s name or Social 

Security number, pursuant to Instruction I3); and, if the Company is providing 

data in multiple records for the Outpatient Episode, a unique Outpatient Episode 

identifier that shall also be included in each record associated with the same 

Outpatient Episode (to protect patient privacy, the Company shall mask personal 

identifying information, such as the patient’s name or Social Security number, 

pursuant to Instruction I3); 

(b) The identity of the Healthcare Facility – including the Treatment location’s 

address, zip code, and Healthcare Facility identification number (e.g., tax 

identification number) – at which the Outpatient Episode occurred, the identity of 

the Healthcare Facility’s owner, and any codes the Company uses to categorize 

each Healthcare Facility, including Medicare Provider ID or NPI number; 

(c) The name, NPI number, and specialty area of practice of each primary physician 

and Mid-level Practitioner who evaluated or treated the patient; 

(d) The identity of the employer or Physician Group of the primary physician or Midlevel Practitioner identified in response to Specification 3(c); 

(e) The patient’s county of residence and the patient’s 5-digit ZIP code of residence; 

(f) The patient’s gender, age (including age in days if the patient is less than one year 

old), race, and ethnicity; 

(g) The date of the Outpatient Episode; 
 

 

 

 

 

 

 

 

 

 

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(h) The Current Procedural Terminology/Healthcare Common Procedure Coding 

System (“CPT/HCPCS”) code(s) and modifier(s) and the Ambulatory Surgical 

Center (“ASC”) and Ambulatory Payment Classification (“APC”) code(s) 

associated with each Treatment, procedure, or service performed, and any other 

code(s), used for billing; 

(i) The primary ICD9 or ICD10 diagnosis code and any secondary ICD9 or ICD10 

diagnosis code(s) associated with the Outpatient Episode; 

(j) The primary ICD9 or ICD10 procedure code and any secondary ICD9 or ICD10 

procedure code(s) associated with the Outpatient Episode; 

(k) A brief description of the service(s), Treatment(s), and/or procedure(s) performed; 

(l) Whether the Treatment, procedure, or service provided was for an emergency; 

(m) The source of the patient (e.g., transfer or referral from another Provider), 

including the identity of any transferring or referring Provider; 

(n) The specific name and type (e.g., HMO, POS, PPO, etc.) of the Health Plan 

product – including the name of the sponsor or patient employer for Self-Insured 

Health Plans – that was the principal source of payment; 

(o) The identity of any secondary sources of payment; 

(p) For each product listed in response to Specification 3(n), whether the product was 

offered through a managed care contract with Medicare, Medicaid, or other public 

health insurance program; 

(q) Whether the Healthcare Facility identified in response to Specification 3(b) was a 

participating Provider under the patient’s Health Plan and, if the patient’s Health 

Plan had different Tiers of participating Providers, which Tier the Healthcare 

Facility was in; 

(r) The billed charges of the Healthcare Facility (broken out by any codes and 

modifiers used for billing), the allowed amount under the patient’s Health Plan, 

the amount actually paid by the Health Plan, and whether the amount actually 

paid by the Health Plan includes any adjustments under any stop-loss provisions; 

(s) A breakdown of the Healthcare Facility’s charges by classification of physician 

services rendered to the patient, by CPT/HCPCS code and modifier or by any 

other diagnosis and/or procedure codes used by the Healthcare Facility; 

(t) Any additional amounts paid or to be paid to the Healthcare Facility by the patient 

under the patient’s Health Plan (broken out by any codes and modifiers used for 

billing), including (and listed separately): 

(i) The Deductible amount; 
 

 

 

 

 

 

 

 

 

 

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(ii) The Copay amount; and 

(iii) The Coinsurance amount; 

(u) Whether the allowed amount identified in response to Specification 3(r) was 

determined under a coordination-of-benefits arrangement, and if it was: 

(i) the identity of the designated primary payor under this arrangement; and 

(ii) what the allowed amount would have been absent the coordination-ofbenefits arrangement; 

(v) Whether this Outpatient Episode is part of a series of Treatment episodes and 

where this Treatment episode falls in that series; and 

(w) The patient’s status (e.g., any morbidity, mortality, or transfer to another 

Healthcare Facility for care) at the end of the Outpatient Episode. If the patient 

was transferred to another Healthcare Facility, identify the Healthcare Facility, 

including the address of the Healthcare Facility (including the ZIP code), any 

Hospital identification number, and the reason for the transfer. 

4. Submit (in electronic, machine readable format directly to the Commission 

representative(s) identified in Instruction I11), for each Practitioner Treatment Episode 

that was performed by a physician or Mid-level Practitioner, that occurred in the period 

January 1, 2015 to the present, and that involved a patient residing in the Relevant Area 

(regardless of the location of the physician or Mid-level Practitioner accessed by the 

patient) or a patient accessing a physician or Mid-level Practitioner in the Relevant Area 

(regardless of the patient’s place of residence): 

(a) A unique patient identifier, different from that of other patients and the same as 

that for different inpatient admissions, Outpatient Episodes, and Practitioner 

Treatment Episodes for the same patient (to protect patient privacy, the Company 

shall mask personal identifying information, such as the patient’s name or Social 

Security number, pursuant to Instruction I3); and, if the Company is providing 

data in multiple records for the Practitioner Treatment Episode, a unique 

Practitioner Treatment Episode identifier that shall also be included in each record 

associated with the same Practitioner Treatment Episode (to protect patient 

privacy, the Company shall mask personal identifying information, such as the 

patient’s name or Social Security number, pursuant to Instruction I3); 

(b) The identity of the Healthcare Facility or office – including the Treatment 

location’s address, zip code, and Healthcare Facility identification number (e.g., 

tax identification number) – at which the Practitioner Treatment Episode 

occurred, and the identity of the Healthcare Facility’s owner; 
 

 

 

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(c) The name, NPI number, the specialty area of practice of each primary physician 

and Mid-level Practitioner who evaluated or treated the patient, and any codes the 

Company uses to categorize each primary physician or Mid-level Practitioner; 

(d) The identity of the employer or Physician Group of the primary physician or Midlevel Practitioner identified in response to Specification 4(c); 

(e) The patient’s county of residence and the patient’s 5-digit ZIP code of residence; 

(f) The patient’s gender, age (including age in days if the patient is less than one year 

old), race, and ethnicity; 

(g) Whether the Practitioner Treatment Episode involved Inpatient Services or 

Outpatient Services; 

(h) A place of service code, either used by Medicare or internal codes, for each 

Practitioner Treatment Episode; 

(i) If the Practitioner Treatment Episode involved inpatient care, the date of 

admission and date of discharge; 

(j) If the Practitioner Treatment Episode involved inpatient care, the DRG or 

MSDRG and the MDC associated with the patient’s admission, and the primary 

ICD9 or ICD10 diagnosis and procedure codes and any secondary ICD9 or ICD10 

diagnosis and procedure codes associated with the patient’s admission; 

(k) If the Practitioner Treatment Episode involved outpatient care, the date of the visit 

or procedure(s); 

(l) If the Practitioner Treatment Episode involved outpatient care, the CPT/HCPCS 

code(s) and modifier(s) and the ASC and APC code(s) associated with each 

service, Treatment, or procedure performed, and any other codes used for billing; 

(m) Whether the practitioner is a salaried employee of the Healthcare Facility where 

the Treatment episode occurred; 

(n) Whether the Treatment provided was for an emergency; 

(o) The source of the patient (e.g., transfer or referral from another Healthcare 

Facility, physician, or emergency department), including the identity of any 

referring or transferring source; 

(p) The specific name and type (e.g., HMO, POS, PPO, etc.) of the Health Plan 

product – including the name of the sponsor or patient employer for Self-Insured 

Health Plans – that was the principal source of payment; 

(q) The identity of any secondary sources of payment; 
 

 

 

 

 

 

 

 

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(r) For each product listed in response to Specification 4(p), whether the product was 

offered through a managed care contract with Medicare, Medicaid, or other public 

health insurance program; 

(s) Whether each Person or Entity identified in response to Specifications 4(c) and 

4(d) was a participating Provider under the patient’s Health Plan, and if the 

patient’s Health Plan had different Tiers of participating Providers, which Tier 

each Provider was in; 

(t) The billed charges of each physician or Mid-level Practitioner (broken out by any 

codes and modifiers used for billing), the allowed amount under the patient’s 

Health Plan, the amount actually paid by the Health Plan, and whether the amount 

actually paid by the Health Plan includes any adjustments under any stop-loss 

provisions; 

(u) Any additional amounts paid or to be paid by the patient to any physician or 

practitioner under the patient’s Health Plan (broken out by any codes and 

modifiers used for billing), including but not limited to (and listed separately): 

(i) The Deductible amount; 

(ii) The Copay amount; and 

(iii) The Coinsurance amount; 

(v) Whether the allowed amount identified in response to Specification 4(t) was 

determined under a coordination-of-benefits arrangement, and if it was: 

(i) the identity of the designated primary Health Plan under this arrangement; 

and 

(ii) what the allowed amount would have been absent the coordination-ofbenefits arrangement; 

(w) Whether this Practitioner Treatment Episode is part of a series of Practitioner 

Treatment Episodes and where this Practitioner Treatment Episode falls in that 

series; and 

(x) The patient’s status (e.g., any morbidity, mortality, or transfer to another 

Healthcare Facility for care) at the end of the Practitioner Treatment Episode. If 

the patient was transferred to another Healthcare Facility, identify the Healthcare 

Facility, including the address of the Healthcare Facility (including the ZIP code), 

any Hospital identification number, and the reason for the transfer. 

5. Identify capitation, risk-sharing, bundled payment, ACO payment, value-based payment, 

lump-sum payment, increased reimbursement or bonuses for meeting quality objectives, 

or any reimbursement contracts other than fee-for-service with providers now in effect or 
 

 

 

 

 

 

 

 

 

 

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that were in effect at any time since January 1, 2015 in the Relevant Area, and for each 

such arrangement provide the following information (in electronic, machine readable 

format directly to the Commission representative identified in Instruction I11): 

(a) A unique identifier for the arrangement; 

(b) The number and dollar value of Claims or Episodes that are covered by the 

arrangement; 

(c) The total bonuses, penalties, and other payments or deductions associated with the 

arrangement that are not already reflected in the claims data for each time period 

for which the bonuses, penalties, payments, or deductions are normally assessed 

and for each provider participating in the program as well as the Tax 

Identification Number (TIN) and any other provider codes (e.g., the NPI number) 

that would allow us to match the provider to the providers in Specifications 2-4; 

and 

(d) The time period in which the payments were accrued; the start date and end date 

of the accrual period. 

6. Describe (in electronic, machine readable format directly to the Commission 

representative(s) identified in Instruction I11), for each provider identified in the response 

to Specifications 2-4, for each calendar year during the period January 1, 2015 to the 

present the relationship between: 

(a) The provider’s NPI; 

(b) The provider’s TIN; 

(c) The provider’s employer or owner; and 

(d) The provider’s negotiating or contracting entity. 

7. Describe (in electronic, machine readable format directly to the Commission 

representative(s) identified in Instruction I11), for each Health Plan (such as HMO, POS, 

PPO, etc.) offered by the Company in the Relevant Area for each calendar year during 

the period January 1, 2015 to the present: 

(a) The name of the product as it is referred to in the Company’s data provided in 

response to Specifications 1-4; 

(b) The specific type (e.g., HMO, POS, PPO, etc.) of the product – including the 

name of the sponsor or patient employer for Self-Insured Health Plans; 

(c) Whether the product is available through an employer, a private exchange, or a 

public exchange; 
 

 

 

 

 

 

 

 

 

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(d) Whether the product was offered through a managed care contract with Medicare, 

Medicaid, or other public health insurance program; 

(e) Whether the product is a High Deductible Health Plan; 

(f) Whether the product is a Fully-Insured Health Plan or a Self-Insured Health Plan; 

and 

(g) The identity of each participating Provider, including the Provider’s affiliation 

with a Hospital, Hospital System, or other larger entity (i) for each physician or 

Mid-level Practitioner, the Provider’s specialty, employer, type of affiliation with 

the Hospital or Hospital System (such as employed, member of physician hospital 

organization, member of clinically integrated network, professional service 

agreement), and indicate whether the affiliated Hospital or Hospital System 

negotiated rates on behalf of the Provider; and (ii) for each Provider, a description 

of any Provider-Tiering or preferred-provider designation pursuant to a Steering 

Program. 

8. Identify (in electronic, machine readable format directly to the Commission 

representative(s) identified in Instruction I11) the code definitions used in the Company’s 

responses to Specifications 2-4 of this Order (e.g., DRG, MSDRG, MDC, ICD9, ICD10, 

CPT, ASC, APC, and version number), including the date on which any change to any of 

these code definitions was implemented by the Company in the period from January 1, 

2015 to the present. If the Company used or uses one or more proprietary procedure 

coding systems in the period from January 1, 2015 to the present, provide for each such 

system: 

(a) The time period during which the Company used the system; 

(b) A master list of the system’s codes; 

(c) A brief description of each code; and 

(d) Each code’s associated weight value, if this value was or is used for billing. 

9. Submit all information described in Instructions I6 and I7 below, and any additional 

instructions necessary for the Commission to use or interpret the data and information 

submitted in response to this Order. 

10. Submit the name(s) and title(s) of the person(s) responsible for preparing the response to 

this Order and a copy of all instructions prepared by the Company relating to the steps 

taken to respond to this Order. Where oral instructions were given, identify the 

individual who gave the instructions and describe the content of the instructions and the 

person(s) to whom the instructions were given. 
 

 

 

 

 

 

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DEFINITIONS 

For the purposes of this Order, the following Definitions apply: 

D1. The term “the Company” means [COMPANY NAME]; its domestic and foreign parents, 

predecessors, divisions, subsidiaries, affiliates, partnerships and joint ventures; and all 

directors, officers, employees, agents, and representatives of the foregoing. The terms 

“parent,” “subsidiary,” “affiliate,” and “joint venture” refer to any person in which there 

is partial (25 percent or more) or total ownership or control between the Company and 

any other person. 

D2. The terms “and” and “or” have both conjunctive and disjunctive meanings. 

D3. The term “Claim” refers to any individual occurrence of a particular medical service at 

the level of detail at which the Provider bills the Company. 

D4. The term “Coinsurance” refers to the set percentage of covered charges (i.e., the charges 

recognized by the Health Plan) that a Health Plan enrollee must pay out-of-pocket for 

each episode of healthcare covered by the enrollee’s Health Plan. The term also has any 

other meaning that the Company ascribes to it in the ordinary course of business. 

D5. The term “Copay” refers to the set fee that a Health Plan enrollee must pay out-of-pocket 

for each episode of healthcare covered by the enrollee’s Health Plan. The term also has 

any other meaning that the Company ascribes to it in the ordinary course of business. 

D6. The term “Deductible” refers to the set amount that a Health Plan enrollee must pay outof-pocket each year for healthcare services before the enrollee’s Health Plan benefits go 

into effect. The term also has any other meaning that the Company ascribes to it in the 

ordinary course of business. 

D7. The terms “each,” “any,” and “all” mean “each and every.” 

D8. The term “Entity” means any natural person, corporation, company, partnership, joint 

venture, association, joint-stock company, trust, estate of a deceased natural person, 

foundation, fund, institution, society, union, or club, whether incorporated or not, 

wherever located and of whatever citizenship, or any receiver, trustee in bankruptcy or 

similar official or any liquidating agent for any of the foregoing, in his or her capacity as 

such. 

D9. The term “Episode” refers to any individual occurrence of a particular medical service. 

D10. The term “Fully-Insured” refers to any arrangement by which a Health Plan is directly 

responsible for paying the Provider claims generated by the healthcare consumption of its 

members. 

D11. The term “General Acute Care Inpatient Services” refers to the provision of Inpatient 

Services (including any Physician Services that may be provided on an inpatient basis) 
 

 

 

 

 

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for medical diagnosis, Treatment, and care of physically injured or sick persons with 

short-term or episodic health problems or infirmities, excluding non-acute long-term 

services (e.g., skilled nursing care). 

D12. The term “Health Plan” means any health maintenance organization, managed healthcare 

organization, preferred provider arrangement or organization, managed healthcare plan of 

any kind, Fully-Insured health benefit plan, Self-Insured health benefit plan, other 

employer or union health benefit plan, Medicare, Medicaid, TRICARE, or private or 

governmental healthcare plan, or health insurance of any kind. 

D13. The term “Healthcare Facility” means any location where Relevant Services are 

delivered, on an inpatient or outpatient basis, including, but not limited to, Hospitals, 

ambulatory surgery centers, urgent care centers, physician offices, locations where 

radiology services or imaging services are delivered, or clinical laboratories. 

D14. The term “High Deductible Health Plan” refers to a Health Plan with a higher annual 

deductible than typical health plans and a maximum limit on the sum of the annual 

deductible and out-of-pocket medical expenses that an individual must pay for covered 

expenses, as defined by the Internal Revenue Service Publication 969, Health Savings 

Accounts and Other Tax-Favored Health Plans. 

D15. The term “Hospital” means a facility that provides General Acute Care Inpatient 

Services, collectively or individually. 

D16. The term “Inpatient Services” refers to the provision of medical services that require at 

least one overnight stay at a Provider or at least 24-hour nursing care, including any 

Physician Services rendered as part of the inpatient Treatment. 

D17. The term “Mid-level Practitioner” means a nurse practitioner or physician assistant. 

D18. The term “Outpatient Episode” means any Practitioner Treatment Episode that involves 

only the delivery of one or more Outpatient Services. 

D19. The term “Outpatient Services” refers to the provision of medical services, including 

physician services, that do not require an overnight stay at a Healthcare Facility or 24-

hour nursing care. 

D20. The term “Person” includes the Company and means any natural person, corporate 

Entity, partnership, association, joint venture, government Entity, or trust. 

D21. The term “Physician Group” means a bona fide, integrated firm in which physicians 

practice medicine together as partners, shareholders, owners, or employees, or in which 

only one physician practices medicine. 

D22. The term “Physician Services” refers to services provided by a physician, Mid-level 

Practitioner, or Physician Group. 
 

 

 

 

 

 

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D23. The term “Plan Sponsor” identifies the entity that provides the health plan that is used by 

an individual. The plan sponsor will vary depending on how the individual obtains health 

benefits. For individuals with employer sponsored insurance, the plan sponsor is the 

employer of the individual who obtains the health care benefit plan for his/her family. 

For individuals with government provided health care, the plan sponsor may be 

Medicaid, Medicare, or some other government plan. Finally, if the individual obtained a 

health benefit plan as an individual policy, the plan sponsor should be indentified as 

“Individual,” and all persons obtaining the identical health care benefit plan should have 

the same plan sponsor identifier. 

D24. The term “Practitioner Treatment Episode” means any individual occurrence when a 

patient visits or receives a Treatment from a physician or other medical professional for 

medical care at one specific location, regardless of whether the Treatment involved 

Inpatient Services or Outpatient Services. 

D25. The term “Provider” means any Entity that provides the Relevant Service. The term 

“Provider” includes but is not limited to Hospitals, freestanding outpatient facilities, 

Physician Groups, individual physicians, and other Healthcare Facilities. 

D26. The term “relating to” means in whole or in part constituting, containing, concerning, 

discussing, describing, analyzing, identifying, or stating. 

D27. The term “Relevant Area” means the states of Colorado, Florida, Georgia, Illinois, 

Indiana, Kentucky, Maine, Missouri, Montana, Nevada, New Hampshire, New Mexico, 

Ohio, Oklahoma, and Texas. 

D28. The term “Relevant Services” as used herein means, and information shall be provided 

separately for, each of the following: (1) General Acute Care Inpatient Services, 

collectively and individually; (2) Outpatient Services, collectively and individually; and 

(3) Physician Services. 

D29. The term “Self-Insured” refers to any arrangement by which an employer or other Health 

Plan customer is directly responsible for paying Provider claims generated by the 

healthcare consumption of its employees or other members. The term includes and refers 

to, without limitation, Administrative Services Only (“ASO”) arrangements. 

D30. The terms “Tier” and “Tiering,” with respect to Providers, refer to the classification of 

some or all of a Health Plan’s in-network Providers into two or more Tiers based on each 

Provider’s costs, quality, other attributes, or some combination of the foregoing, such that 

each Health Plan member faces different out-of-pocket costs across the various Tiers for 

the same Treatment, service, or procedure. 

D31. The term “Treatment” is defined as any individual occurrence when a patient receives 

medical attention (such as a diagnosis, clinical procedure, surgery, imaging service, 

rehabilitation session, visit, or any other medical assessment, care, procedure, or action) 

from a physician or other medical professional at one specific location, including a 

physician office. 
Order to File Special Report (COMPANY NAME)

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D32. Any word or term that the Company considers vague or insufficiently defined has the 

meaning most frequently assigned to it by the Company in the ordinary course of 

business. 
 

 

 

 

 

 

 

 

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INSTRUCTIONS 

For the purposes of this Order, the following Instructions apply: 

I1. All references to year refer to calendar year. Where data/information is requested, 

provide it separately for each calendar year; if calendar year data/information is not yet 

available, provide the data/information for the calendar year to date. If calendar year 

data/information is not kept by the Company, supply the Company’s fiscal year 

data/information, indicating the 12-month period covered, and provide the Company’s 

best estimate of calendar year data/information. 

I2. In order to comply in a manner consistent with the Commission’s Rules of Practice, 16 

C.F.R. § 2.7(k), the Company shall schedule a teleconference, within 14 days after 

receiving this Order, with the Commission representative identified in Instruction I12 of 

this Order to confer regarding production format and method. Upon request, an 

extension of no more than 30 days for the teleconference may be granted in writing by a 

Commission official. 

I3. To protect patient privacy, the Company shall mask personal identifying information, 

such as the patient’s name, Social Security number, patient medical record number, 

insurance ID, employer, and health plan identifier by substituting (a) a unique patient 

identifier that is different from that for other patients and the same as that for different 

admissions, discharges, or other treatment episodes for the same patient; (b) a unique 

inpatient admission or outpatient visit identifier; (c) an employer identifier that is unique 

for a given employer and common to all patients whose health benefits are provided by 

that employer; and (d) a health care plan identifier that is unique for a given health care 

plan and common to all patients that receive health care benefits from that health care 

plan. 

I4. The Company shall submit data in delimited text or Microsoft Excel format. Other 

formats should be discussed with the Commission representative identified in Instruction 

I11 of this Order. 

I5. The Company shall encrypt all data and information before producing it to the 

Commission. Using NIST FIPS-Compliant1

 cryptographic hardware or software 

modules is strongly encouraged. All submissions in electronic format shall be produced 

in the following manner: 

1 The National Institute of Standards and Technology (NIST) issued the Federal Information Processing Standard 

(FIPS) Publications 140-1 and 140-2 that details certified cryptographic modules for use by the U.S. Federal 

government and other regulated industries that collect, store, transfer, share, and disseminate sensitive but 

unclassified information. More information about FIPS 140-1 and 140-2 can be found at 

http://csrc.nist.gov/groups/STM/index.html. 
 

 

 

 

 

Order to File Special Report (COMPANY NAME) 

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(a) For any submission over 10 gigabytes, use IDE and EIDE hard disk drives, 

formatted in Microsoft Windows-compatible, uncompressed data; data can be 

provided on a FIPS-Compliant encrypted hard drive. 

(b) For any submission under 10 gigabytes, use CD-R, CD-ROMs, and DVD-ROM 

for Windows-compatible personal computers, and USB 2.0 Flash Drives are also 

acceptable storage formats. 

(c) All information produced in electronic format shall be scanned for and free 

of viruses. The Commission will return any infected media for replacement, 

which may affect the timing of the Company’s compliance with this Order. 

(d) The password for the encrypted data and information shall be provided 

separately, via email, to the Commission representative identified in 

Instruction Il1 of this Order. 

However, the Company may produce any data/information responsive to this Order using 

the Commission’s secure file transfer protocol (“FTP”). For instructions on using this 

FTP, please contact the Commission representative identified in Instruction I11 of this 

Order. 

I6. Each submission responsive to this Order shall be accompanied with a letter that includes 

all of the following: 

(a) Volume name; 

(b) A description of encryption software/hardware used; 

(c) The total number of files; and 

(d) A list of data fields in the Order in which they appear in the data files. 

I7. Each data submission responsive to this Order shall be accompanied by a description of 

each data field, a data dictionary that specifies what the values of each data field signify, 

and an identification of the field(s) that respond(s) to each subpart of Specifications 1-8 

of this Order. 

I8. The Company shall submit documents as instructed below absent the written consent by a 

Commission official. 

(a) Documents stored in electronic or hard copy format in the ordinary course of 

business shall be submitted in electronic format provided that such copies are 

true, correct, and complete copies of the original documents: 

(i) Submit Microsoft Access, Excel, and PowerPoint in native format with 

extracted text and metadata; 
 

 

 

 

 

Order to File Special Report (COMPANY NAME) 

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(ii) Submit all documents other than those identified in subpart (a)(i) in image 

format with extracted text and metadata; and 

(iii) Submit all hard copy documents in image format accompanied by OCR. 

(b) Documents responsive to this Order, regardless of format or form and regardless 

of whether submitted in paper or electronic form: 

(i) Shall be produced in complete form, un-redacted unless privileged or as 

required by I3, and in the order in which they appear in the Company’s 

files, and shall not be shuffled or otherwise rearranged. For example: 

(1) If in their original condition papers were stapled, clipped, or 

otherwise fastened together or maintained in file folders, binders, 

covers, or containers, they shall be produced in such form, and any 

documents that must be removed from their original folders, 

binders, covers, or containers in order to be produced shall be 

identified in a manner so as to clearly specify the folder, binder, 

cover, or container from which such documents came; and 

(2) If in their original condition electronic documents were maintained 

in folders or otherwise organized, they shall be produced in such 

form and information so as to clearly specify the folder or 

organization format; 

(ii) If written in a language other than English, shall be translated into 

verbatim English, with the English translation attached to the foreign 

language document; 

(iii) Shall be produced in color where necessary to interpret the document; 

(iv) Shall be marked on each page with corporate identification and 

consecutive document control numbers; and 

(v) Shall be accompanied by an affidavit of an officer of the Company stating 

that the copies are true, correct, and complete copies of the original 

documents. 

I9. If the Company is unable to answer any question fully, supply such information/data as is 

available. Explain why such answer is incomplete, the efforts made by the Company to 

obtain the information/data, and the source from which the complete answer may be 

obtained. If books and records that provide accurate answers are not available, enter best 

estimates and describe how the estimates were derived, including the sources or bases of 

such estimates. Estimated data should be followed by the notation “est.” If there is no 

reasonable way for the Company to make an estimate, provide an explanation. 
 

 

 

 

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I10. In order for the Company’s response to this Order to be complete, the attached 

certification form must be executed by the official supervising compliance with this 

Order, notarized, and submitted along with the responsive materials. No official of the 

Company need appear to testify with the responsive materials, but the Commission 

reserves the right to have a Company representative testify as to the adequacy of the 

return at a later date. 

I11. The responses to Specifications 1-8 of this Order shall be addressed to the attention of 

“BE Data Support Center” and delivered, between 8:30 a.m. and 4:30 p.m. ET on any 

business day prior to and including the return date stated on the face of the attached 

Order, to BE Data Support Center, Federal Trade Commission, 600 Pennsylvania Ave., 

NW, Room H-285, Washington, DC 20580. For courier delivery, contact Kevin 

I12. Any questions that you have relating to the scope or meaning of anything in this Order or 

suggestions for possible modifications to it should be directed to Stephanie A. Wilkinson 

Please notify Ms. Wilkinson by email in advance 

of each delivery to the BE Data Support Center. 

at 202-326-2084, swilkinson@ftc.gov. 

Richardson at (202) 326-3481, krichardson@ftc.gov; or Constance Herasingh at (202) 

326-2147, cherasingh@ftc.gov. Please notify Mr. Richardson and Ms. Herasingh by 

email in advance of each delivery. Any password(s) necessary to access the response to 

the Order shall be emailed to Mr. Richardson and Ms. Herasingh. 
 

 

 

 

 

 

_______________________________________________________ 

_______________________________________________________ 

_________________________________ 

Order to File Special Report (COMPANY NAME) 

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CERTIFICATION 

This Special Report, together with any and all appendices and attachments thereto, was 

prepared and assembled under my supervision in accordance with instructions issued by the 

Federal Trade Commission. To the best of my knowledge, the information is true, correct, and 

complete, subject to the recognition that, where so indicated, reasonable estimates have been 

made because books and records do not provide the required data. Where copies rather than 

original documents have been submitted, the copies are true, correct, and complete. 

TYPE OR PRINT NAME AND TITLE 

(Signature) 

Subscribed and sworn to before me at the City of ________________, 

State of ______________, this __________ day of ___________, 20__. 

 (Notary Public) 

My Commission expires: