The Source Blog

On April 1, 2025, the Federal Trade Commission (FTC) filed for a stay in a case against three Pharmacy Benefit Managers (PBMs), not because of any lack of evidence, but rather because there was no one left at the FTC to pursue the case due to recent firings by the current administration. When the suit was filed, it was supported by the three Democrat Commissioners, and the two Republican Commissioners recused themselves. A last-minute reversal of a previous recusal may have put the suit back into motion, but the entire […]

The Source team, in conjunction with The Petris Center and Catalyst for Payment Reform, has had new research published on hospital consolidation across geographic markets.  Consolidation among health systems has resulted in increased prices and caused the cost of employer-sponsored health benefits to increase much faster than inflation over the past few decades. Prior quantitative research demonstrates small, but significant price increases resulting from transactions that expand the geographic footprint of health systems, but the mechanisms by which these cross-market acquisitions raise prices is not completely resolved.  The methodology of this […]

Department of Justice Looking Into United Health On February 21, 2025, the Wall Street Journal reported that the Department of Justice (DOJ) has launched a civil fraud investigation against UnitedHealth.  The investigation is centered on Medicare billing practices, with sources saying that UnitedHealth-employed physicians were trained to document higher revenue-generating diagnoses, even if that was not what patients were being treated for.  Additionally, the investigation is apparently looking into claims that UnitedHealth used software to suggest additional codes and offered bonuses to clinicians who coded for these additional diagnoses.  If […]

The long-standing saga of Sidibe v. Sutter may finally be over.  The case, initially filed in federal district court for the Northern District of California in September 2012, has a long and convoluted history of complaints, amended complaints, a district court dismissal, an appeals court reversal, a summary judgment of some causes of action, a jury trial, and an appeal, among other steps. On March 2, 2025, the parties filed a notice in the U.S. District Court for the Northern District of California stating that an agreement in principle to […]

On December 23, 2024, Aetna (part of CVS Health) filed a lawsuit against Radiology Partners and its private equity backers in the U.S. District Court for the Middle District of Florida – Jacksonville Division.  The suit claims Radiology Partners, one of the nation’s largest imaging groups, manipulated the No Surprises Act (NSA) and its dispute resolution process to boost payments improperly.  Aetna’s filing called this a “multiphase healthcare fraud scheme” that defrauded Aetna of “tens of millions” of dollars. Update: On February 25, Radiology Partners filed two motions: one to […]

In November of 2024, three lawsuits were filed by pharmaceutical manufacturers against the Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA), challenging how HRSA oversees the Federal 340B Drug Pricing Program.  (HRSA is the sub-agency within HHS that administers the 340B Program). The potential impact of the lawsuits on the 340B Program is significant in its own right, but the outcome of the lawsuits could also have an indirect effect on merger and acquisition activity.  Research has indicated that the merger and acquisition […]

Healthcare market oversight at the federal level is primarily done through litigation brought by the Federal Trade Commission (FTC) or the Department of Justice (DOJ).  Any change in administration in Washington will change the focus and priority of these agencies.  Nonetheless, the second Trump administration has indicated that it will make wholesale changes to federal agencies, including the FTC and DOJ, that exceed those that are typical during a change in administration.  These indications raise many questions about the new role of the FTC and DOJ in healthcare markets: How […]

On November 7, California Governor Gavin Newsom called for a special session of the California Legislature to take steps to protect California from anticipated changes driven by the new Trump administration.  While many of the Governor’s areas of concern are not directly related to healthcare (including protecting civil rights, climate action, and immigrant families), there is a focus on reproductive rights, women’s rights and LGBTQ+ rights. The special session convened on December 2.  The primary goal of the session is to provide additional resources to the state Department of Justice […]

On October 18, 2024, the North Carolina Supreme Court unanimously ruled to send a case challenging the states Certificate of Need (CON) law back to a lower court.  Certificate of Need laws require healthcare providers and facilities to get permission from the state government before adding or expanding healthcare services, equipment, or facilities.  To get this permission, the provider must show that the new service is needed, hence the name. The case in North Carolina originated in April 2020 when Dr. Jay Singleton, an eye surgeon, filed suit against legislative […]

On September 23, 2024, Particle Health, a startup that aggregates and shares data among healthcare providers and health technology companies, filed suit in the U.S. District Court for the Southern District of New York against Epic Systems, the nation’s largest vendor of electronic health records.  The suit alleges that Epic is using its market power to destroy competition and represents a challenge to Epic’s dominance in the patient data marketplace. Parties to the Suit Epic is a software company that provides electronic health record (EHR) resources for hospitals and health […]