This post is part of our ongoing coverage of the CHA v. OHCA lawsuit. See case page here. In this post, we examine the claims made by the California Hospital Association (CHA) in its recent lawsuit filed against the California Office of Health Care Affordability (OHCA) regarding OHCA’s plan to implement spending targets for hospitals (Case #  CPF25519370).  While many stakeholders, including CHA, the California Medical Association (CMA), and others, have expressed concerns about the spending targets announced by OHCA and the methodology used to establish them, dissatisfaction with an administrative […]

August and September 2025 were active months in the U.S. Chamber of Commerce’s case challenging the Federal Trade Commission (FTC)’s new rules under the Hart-Scott-Rodino (HSR) Act.  The FTC finalized changes to the HSR pre-merger notification rules in October 2024, and the Chamber filed suit in January 2025. In August and September, the Chamber moved for summary judgment, the FTC filed a brief in opposition, and most recently, the Chamber filed a brief in support of its summary judgment motion. History of the Hart-Scott-Rodino Act Congress passed the original Hart-Scott-Rodino […]

On August 13, 2025, President Donald Trump issued an executive order revoking Executive Order 14036 (Promoting Competition in the American Economy) issued by President Joe Biden on July 9, 2021.  Biden’s executive order was remarkably lengthy and detailed, addressing many areas with significant implications for healthcare markets and competition.  Revoking the order represents a new direction in the Federal Government’s competition priorities. Biden’s Order on Promoting Competition Biden’s 2021 order was unusual in its scope and size, signaling an intention to reinvigorate antitrust enforcement across U.S. industries. The order noted […]

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 […]

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 […]