In an encouraging boost to efforts to promote healthcare competition and price transparency, President Biden signed a sweeping executive order that targets consolidation and lack of competition in the healthcare industry, among others. As part of the Executive Order on Promoting Competition in the American Economy released on July 9th, the President targeted specific market players in the healthcare sector, including hospitals, health insurers, and prescription drug manufacturers. The Executive Order affirms the policy of the Biden Administration “to enforce the antitrust laws to combat the excessive concentration of industry, …

In this mid-year issue of Litigation and Enforcement Highlights, we provide updates on  several pending healthcare transactions. As much of the country recovers from COVID-19, healthcare entities continue to actively pursue proposed mergers and affiliations that could further change the landscape of the healthcare market. In the last update, federal enforcement agencies saw a mixed bag of results to their enforcement efforts, with an FTC loss against Jefferson-Albert Einstein, a DOJ settlement with Geisinger-Evangelical, and several proposed mergers that buckled under antitrust scrutiny (see case reference table below). Since then, …

See case page: Sidibe v. Sutter Health   As all eyes were fixated on UFCW & Employers Benefit Trust v. Sutter Health (UEBT), the landmark state antitrust lawsuit that the California attorney general brought against Sutter Health, another long-standing litigation against Sutter in federal court for similar claims has largely gone under the radar. With the final judgment in the state action set to be approved in state court this July, we turn our attention to Sidibe v. Sutter Health, the other case to watch in the ongoing antitrust challenge against …

This month in Litigation and Enforcement Highlights, we dive into a pair of healthcare antitrust lawsuits that is making the headlines. In late March, a group of doctors sued United Healthcare Insurance in Colorado and Texas in state courts, alleging the insurance giant violated state antitrust laws. Plaintiffs U.S. Anesthesia Partners (USAP) is a physician practice group made of anesthesiologists who practice in nine states. In the complaints, they claimed that United Healthcare used its market power to “squeeze” the group out of its insurance network and the marketplace for …

In this month’s Litigation and Enforcement Highlights, we provide the latest updates on several proposed provider mergers, many of which were fueled by the continued pandemic. With the increased consolidation came increased antitrust scrutiny. So far this year, we’ve seen a mixed bag of wins and losses for federal and state enforcement agencies that seek to block the mergers.   FTC Concedes in Failed Challenge of Jefferson-Albert Einstein Merger In its first major loss in a healthcare merger challenge in recent years, the Federal Trade Commission (FTC) officially dropped its …

The COVID-19 pandemic has brought national attention to the inner workings of the healthcare industry, exposing many of its shortcomings and issues. Many are now taking a renewed look at the U.S. healthcare system as a whole and the underlying problems that arise from the actions of its various players. Early this year, healthcare transactions that have largely escaped federal antitrust review are now being hauled into the spotlight in new attempts to promote greater competition in the healthcare market.   Physician Consolidation Garners Attention as the FTC Seeks to …

We kick off the new year with a handful of new developments in healthcare litigation and enforcement that transpired at the end of 2020. In price transparency, a pair of legal challenges intended to block transparency efforts in drug pricing and hospital pricing, respectively, were denied by the circuit courts. On the antitrust front, the Federal Trade Commission saw both victory and defeat in its challenges of proposed mergers that would lessen competition in the healthcare markets.   Judges Refuses to Block California’s Drug Pricing Transparency Law SB 17 On …

As the COVID-19 pandemic continues to ravage the nation, it has put economic stress on smaller healthcare providers, giving larger health systems the opportunity to gain market power through more rampant merger and acquisition activity. In response, the Federal Trade Commission and the Department of Justice also stepped up their antitrust enforcement efforts. In this year-end Litigation and Enforcement Highlights issue, we round up federal enforcement challenges of provider mergers in 2020 and look at the latest status of these actions.   Jefferson Health/Albert Einstein (Pennsylvania) The Federal Trade Commission …

Editor’s Note: An abbreviated summary of this case appears in the research report “Preventing Anticompetitive Contracting Practices in Healthcare Markets”, which provides a detailed analysis of anti-tiering/anti-steering clauses, including economic justification and procompetitive use and states that have restricted its use in healthcare contracts.   The antitrust case against Sutter Health in California has drawn the attention of state regulators and policymakers across the country, spawning legislative reform efforts to curb dominant hospitals’ market power. Prior to this, an enforcement action against Atrium Health, a large health system on the …

The private antitrust case against Blue Shield/Blue Cross (BCBS) reached a preliminary partial settlement last month after eight years of litigation. A driving force for this settlement may have been the April 2018 district court ruling that was seen as a serious blow to the defendants. In two antitrust suits that have been consolidated in Alabama federal court (put into Multi-District Litigation),[1] healthcare providers and employer subscribers sued BCBS companies across the country, alleging horizontal market allocation in violation of Section 1 of the Sherman Antitrust Act. The plaintiffs claim …