The Source Blog

On February 20, 2026, the Department of Justice (DOJ) and the Ohio Attorney General’s office filed suit against OhioHealth, a 16-hospital nonprofit health system, claiming that OhioHealth’s use of all-or-nothing terms (requiring insurers to include all of its providers in their networks) inflates costs for policyholders and disadvantages competitors.  The suit also claimed that OhioHealth’s contracts included terms requiring OhioHealth to be at the most-favored level of benefits in each network, and that payors were prevented from providing patients with price information about healthcare services.  The Source published an analysis of this case in March.

On June 16, the Department of Justice announced a proposed settlement to resolve the case.  On June 17, the Ohio Attorney General’s Office issued its own statement announcing the proposed settlement.

Key Details of the Agreement

The terms of the settlement include:

• OhioHealth will not use contract provisions that prevent insurers from steering patients toward lower-cost providers. However, for any Narrow Network in which OhioHealth is the most-prominently featured provider, OhioHealth can restrict steerage within that Narrow Network.
• OhioHealth will not require insurers to include OhioHealth in their most-preferred tier, but OhioHealth may seek to participate in the most-preferred tier of a Benefit Plan.
• OhioHealth will not use contract provisions that deter transparency, allowing insurers to communicate with patients about healthcare prices and quality. OhioHealth is allowed to use confidentiality provisions that prevent payors from “disseminating price or cost information to Defendant’s competitors, other Payors, or the general public”.
• For five years, OhioHealth must provide quarterly reports to the DOJ, the Ohio AG, and an independent monitor, to ensure compliance.

The settlement does not include any admission of wrongdoing by OhioHealth and imposes no fines, penalties, or damages against OhioHealth.  Notably, each of these commitments also comes with a carve-out, and those exceptions may limit the practical effect of the settlement.  A similar carve-out for co-branded plans appeared in the consent decree that the DOJ negotiated with Atrium that allowed tiering restrictions in network in co-branded plans, for example, the Blue Cross plan branded around Carolinas HealthCare System.

Reactions

In the DOJ’s press release, Acting Attorney General Todd Blanche stated, "Today's settlement is another example of how this Department of Justice is bringing down healthcare costs for consumers and fighting the anticompetitive behavior that drove them up in the first place."

Ohio Attorney General Andy Wilson added that “Healthcare works best when patients have clear choices and honest information,” and that “[t]his settlement promotes fairness and creates a better system for everyone.”

In its press release, OhioHealth “maintains their contracting practices were and are lawful and appropriate” and added that “no insurer had requested that OhioHealth remove any of the provisions that were the focus of the lawsuit.”

Ramifications From the Proposed Settlement

Because this case was settled rather than decided by the court (similar to many other anticompetitive contracting cases), questions remain about whether courts will rule that contracts containing such restrictions constitute violations under Section 1 of the Sherman Act. The Department of Justice and state attorneys general have brought similar contracting cases before, including the 2018 federal consent decree with Atrium Health in Charlotte, North Carolina and California’s 2019 settlement with Sutter Health. In the related federal class action against Sutter (Sidibe v. Sutter Health), a jury sided with Sutter in 2022, but the Ninth Circuit vacated that verdict in 2024 and the parties settled for $228.5 million before a retrial, so no court has held that all-or-nothing, anti-steering, most-favored-tier, or anti-transparency terms in health care contracts violate Section 1.

The proposed consent judgment in the OhioHealth care was entered without a trial or adjudication of any issue of fact or law and without any admission by OhioHealth, so it is not a judicial finding that these terms are unlawful. Nonetheless, the settlement will likely affect health insurers seeking to design commercial health plans in central Ohio, including their ability to use narrow networks, tiered networks, and steering.  Consolidated must-have hospital systems in other areas may choose to review their use of contracting terms in light of the heightened scrutiny from federal and state enforcers.  Specifically, the settlement highlights specific terms potentially used by other systems that could draw unwanted attention from enforcers.

Interestingly, Exhibit A of the settlement includes “Examples of contract provisions that are void and unenforceable according to the Final Judgment," which would seem to provide a blueprint for other healthcare systems looking to avoid the ire of enforcers.  Notably, the prohibited contract example terms include "make-whole" provisions.  A make-whole provision obligates the insurer to compensate the system for revenue or volume it would otherwise have received but for the insurer's plan design. If the insurer builds a tiered product, a narrow network, a site-of-service incentive, or any benefit design that diverts enrollees toward lower-cost competitors, the system is "made whole" for the diverted volume. The effect is the same or worse than anti-steering bans, because one of the mechanisms by which an insurer can discipline a dominant system's prices is through a credible threat to decrease their volume; a make-whole strips the financial payoff out and an insurer would not capture any savings from steering.  As a result, an insurer has little reason to invest in a tiered or narrow products that would put downward pressure on the system's rates, and the system's volume, and therefore its pricing power, stays insulated..

Importantly, the government did not allege the anticompetitive use of make-whole provisions in the complaint, but rather alleged the use of anti-steering, anti-tiering, and all-or-nothing. The make-whole mechanism only appears in the remedy, which likely indicates that the DOJ wanted to prohibit yet another contractual obligation that mutes competition.

Next Steps

As required by law, the U.S. District Court for the Southern District of Ohio cannot enter the final judgment until the proposed settlement is published in the Federal Register and a 60-day public comment period ends.  A similar case is pending in New York against New York Presbyterian (NYP).  NYP has insisted that the contract terms they use are industry-standard, requested by the insurers, and pro-competitive.  Would NYP be willing to settle for terms similar to OhioHealth's, or will they push the DOJ to settle the matter in court?  And will the attention being placed on hospital-payor contract terms by enforcers result in other healthcare systems making changes to their contracting practices?

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