The Source Blog

On September 5, 2025, the Federal Trade Commission (FTC) announced it would dismiss its appeal of a 2024 court ruling that had determined that the FTC’s attempt at creating a federal noncompete ban had exceeded the FTC’s authority.  Ending the legal defense of the noncompete ban effectively ends any chance of the ban going into effect. This saga began on April 23, 2024, when the FTC issued a rule banning many noncompete clauses in employee contracts, which was quickly challenged when several parties filed lawsuits against the rule.  On July […]

Steering methods, where health plans are able to incentivize patients to choose high-value, cost-effective care can be critical to the financial health of these plans.  New York–Presbyterian Hospital is facing mounting legal and regulatory challenges over allegations that it sought to limit competition and prevent insurers from steering patients to lower-cost options.  On July 25, 2025, the Cement and Concrete Workers DC Benefit Fund, a self-funded union health plan, filed suit against The New York and Presbyterian Hospital, claiming that New York Presbyterian (NYP) engaged in various anti-steering efforts in […]

Update: On Monday, July 28, 2025, U.S. District Court Judge Brian Miller issued a preliminary injunction blocking the law (which would have taken effect on January 1, 2026) until the federal court issues final judgement. In April 2025, Arkansas passed legislation prohibiting pharmacy benefit managers (PBMs) from acquiring or holding a direct or indirect interest in pharmacies.  This law makes Arkansas the first state to enact a structural approach to address concerns about PBM business practices.  To date, three separate lawsuits have been filed challenging the law.  This article looks […]

On July 3, 2025, a three-judge panel of the 9th U.S. Circuit Court of Appeals upheld an Oregon state law that allows the state to review, approve or deny proposed health care mergers, affirming a lower court ruling from May of last year. History of the Case The Oregon Association of Hospitals and Health Systems (OAHHS – a trade association representing Oregon hospitals and health systems) originally filed suit in Federal District Court October 2022 challenging the constitutionality of an Oregon law enacted in 2021, that required health care entities […]

On May 21, 2025, a three-judge panel of the Sixth Circuit Court of Appeals in Ohio reversed a lower court’s decision to dismiss a case filed by Tiara Yachts against Blue Cross Blue Shield of Michigan (BCBSM).  The rulings hinged on whether BCBSM acted as an Employee Retirement Income Security Act (ERISA) fiduciary when administering Tiara Yachts’ self-funded insurance plan.  The lower Court had ruled that BCBSM’s actions did not qualify as fiduciary conduct under ERISA, claiming that the case was a contractual dispute as the complaint was covered by […]

On November 18, 2024, Owens & Minor, Inc. (OMI), a business that sponsors a self-funded healthcare plan for its employees, filed suit against Anthem Health Plans of Virginia, in its role as third-party administrator (TPA), claiming Anthem withheld information and engaged in financial misconduct, and challenging the function of the BlueCard program.  On April 22, 2025, Chief U.S. District Judge R. David Proctor issued an injunction stopping the case due to the settlement terms of a previous class action antitrust lawsuit against Blue Cross Blue Shield (BCBS). Lawsuits like the […]

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 […]