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 […]

Market Consolidation and Merger Review The Forgotten Anti-Monopoly Law: The Second Half of Clayton Act Section 7 (Texas Law Review) Robert H Lande, John M Newman, Rebecca Kelly Slaughter The authors of this article analyze the second prong of Section 7 of the Clayton Act, which prohibits mergers that “tend to create a monopoly.” In comparison to the well-known first prong that seeks to “substantially lessen competition,” the second prong is posited to wield more statutory power as it does not contain a requirement for a certain degree of harm […]

The California State Legislature kicked off the first year of its 2025-2026 biennial Legislative Session on December 2, 2024. This year, the legislature got off to a sprinting start as it raced to meet the February 21, 2025 deadline to introduce new bills. Compared to last year, this year’s legislature proposed a wider swath of bills aimed at healthcare-related concerns, including enhanced merger review, the use of artificial intelligence (AI) in healthcare, and expanding access to both provider and coverage options for consumers. In this month’s California Legislative Beat, we […]

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 […]

Private Equity in Healthcare The Rise of Private Equity in Health Care  — Not a Uniquely American Phenomenon (The New England Journal of Medicine) Yashaswini Singh, Erin Fuse Brown, and Irene Papanicolas Private equity investment in the United States has become an increasingly hot topic – with many debating whether the industry’s prioritization of short-term profitability over long-term investments make it an appropriate fit for patient care. While the issue of private investment in healthcare may appear to many to be a uniquely American phenomenon, given this country’s market-based system, […]

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 […]

On January 10, 2025, Governor Newsom released his proposed California state budget for the 2025-26 term. Following last year’s $46 billion budget shortfall, the Governor’s new budget looked quite different this year. Specifically, the budget had no deficits, reporting a projected surplus of $363 million due to the state’s prediction that it will collect almost $17 billion more in revenue than was originally planned. In fact, this year is slated to go down as California’s second-largest state spending plan ever, at a value of almost $322 billion. Overview of the […]

Healthcare Pricing Can Public Option Plans Improve Affordability? Insights From Colorado (Health Affairs Forefront) Roslyn Murray, Christopher M. Whaley In the face of individuals and families unable to afford increasing insurance premiums due to lack of healthcare insurance competition, a variety of states are considering offering public option plans, commonly for ACA Exchange plans. These plans seek to provide coverage with low premiums by means of capped prices for those who do not meet Medicare or Medicaid requirements nor receive private coverage through employment. The article describes Colorado’s effective public […]