Antitrust Enforcement
Case Brief: Highlights from the District Court Decision Blocking the Aetna-Humana Merger
Anna Zaret, Managing Editor January 31, 2017
The United States District Court for the District of Columbia recently issued its decision in the Department of Justice’s challenge to the proposed merger between Aetna and Humana, two of the largest health insurance companies in the nation. The complaint filed in July 2016 alleged that the merger violated Section 7 of the Clayton Act. DOJ argued that the merger would substantially lessen competition in two markets: (1) the Medicare Advantage market in 364 counties, and (2) the ACA Exchange market in 17 counties. The decision, issued on January 23, …
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Academic Articles & Reports Roundup: December 2016
Anna Zaret, Managing Editor January 4, 2017
Happy New Year everyone! As we wrapped up 2016, we saw several fascinating and comprehensive articles published on competition issues in health insurance and provider markets, including articles discussing (1) the relationship between insurer market participation and provider market power|(2) economic models of decreased insurance competition|(3) the Anthem-Cigna antitrust trial|and (4) the role of quality in hospital merger cases. We hope you enjoy! Insurer Market Participation &|Provider Market Power Daria Pelech’s article Dropped Out or Pushed Out? Insurance Market Exit and Provider Market Power in Medicare Advantage (Journal of …
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Source Advisory Board Member Thomas Greaney Discusses the Evidence in Anthem-Cigna Merger Trial
Anna Zaret, Managing Editor December 30, 2016
The first phase of the Anthem-Cigna merger trial ended on December 20, 2016 (see our blog post with updates on the trial here). In the case, DOJ is arguing that the $48 billion merger between Anthem and Cigna, two of the nation’s largest health insurers, violates federal antitrust law. To lay out the issues and offer predictions about how the court may decide the case, Health Affairs Blog published this article on the case by Source Advisory Board Member Thomas Greaney titled The Anthem/Cigna Merger Trial: Sifting Through The Evidence. In the post, Professor …
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Academic Articles & Reports Roundup: October 2016
Anna Zaret, Managing Editor November 1, 2016
We hope you had a happy Halloween! October’s roundup includes articles covering 1) price transparency|2) provider collaborations in California|3) antitrust doctrine on state immunity|4) payment reforms|and 5) consumer healthcare costs. For the next few months, we will be using the Roundup to focus on a few great healthcare price and competition articles, rather than reporting on a wider array of articles that came out in the month. If you think we have overlooked any interesting articles, please feel free to send us what we’ve missed! Price Transparency In The New …
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Update: Carolinas Healthcare Cites DOJ Second Circuit Loss in Anti-Steering Case
Anna Zaret, Managing Editor October 17, 2016
October 2016 Update: We have been following the suit filed in June by the Department of Justice and the North Carolina Attorney General against Carolinas Healthcare System (“CHS”). The case involves a Sherman Act Section 1 challenge to “anti-steering provisions” in CHS’ contracts with insurers. Last week, CHS filed a supplemental brief arguing that the case should be dismissed because a new Second Circuit decision rejected many of the government’s arguments in an anti-steering case involving American Express. CHS’ brief extends on its line of attack on the DOJ’s complaint, …
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FTC Wins Appeal in Pennsylvania Hospital Merger Case
Anna Zaret, Managing Editor September 28, 2016
On Tuesday, the FTC won its appeal in the Third Circuit, and obtained a preliminary injunction temporarily blocking the merger of the two largest hospital systems in the Harrisburg, Pennsylvania, area. The FTC sued to block the merger of Penn State Hershey Medical Center and Pinnacle Health System in December, but in May a district court judge denied the FTC’s motion for a preliminary injunction. Source Advisory Board member Thomas L. Greaney discussed the case in an earlier blog post, which highlighted the challenges posed by a recent string of …
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Update: Carolinas Healthcare Argues DOJ Fails to Allege Actual Competitive Harm in Anti-Steering Suit
Anna Zaret, Managing Editor September 24, 2016
September 2016 Update: We previously blogged about the suit filed in June by the Department of Justice and the North Carolina Attorney General against Carolinas Healthcare System (“CHS”). The case involves a Sherman Act Section 1 challenge to anti-steering provisions in CHS’ contracts with insurers. In August, CHS moved for judgment on the pleadings. CHS filed its reply brief in support of the motion on Wednesday. In its brief, CHS argues that the DOJ complaint is insufficient as a matter of law because it fails to show that the anti-steering …
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Expert Economists Author Letter Clarifying Relevant Product Market Definition for Aetna/Humana Merger Challenge
Anne Marie Helm, Managing Editor July 25, 2016
Last week’s big news was that the Department of Justice and a number of states have challenged Aetna’s proposed merger with Humana. As in any merger challenge, the way that the relevant product and geographic markets are defined is crucial to the court’s determination of whether the merger should be enjoined. According to the DOJ’s (and other states’) complaint, this merger would combine one of the two largest insurers of Medicare Advantage (Humana) with the fourth largest (Aetna). This, the complaint alleges, would further concentrate 364 county Medicare Advantage markets that are …
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Update: Appeals Court Reinstates Florida Plaintiffs’ Class Claims in Challenge to Unreasonable Hospital Rates
Anne Marie Helm, Managing Editor July 20, 2016
July 2016 Update: In April, the U.S. Court of Appeals for the 11th Circuit overturned the district court’s February 2015 decision dismissing the class-wide allegations in this case. The case charges certain Florida medical centers and Nashville, Tenn.-based HCA with billing exorbitant and unreasonable fees for emergency radiological services covered in part by Florida Personal Injury Protection (“PIP”) insurance. Under Florida’s No Fault Car Insurance Law, drivers are required to have $10,000 in PIP insurance, and the complaint alleges that patients covered by PIP who received radiological services at emergency rooms following …
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Sutter Plaintiffs Win 9th Circuit Appeal of 2014 Case Dismissal
Anne Marie Helm, Managing Editor July 18, 2016
At long last, a three-judge panel has ruled in favor of the plaintiffs/appellants in their Ninth Circuit appeal of the dismissal of the putative class action Sidibe v. Sutter Health, filed in federal district court in San Francisco in September 2012 and dismissed in June 2014. The Ninth Circuit heard arguments on July 8, and issued this unpublished opinion a week later. The district court dismissed the third amended complaint on the grounds that the plaintiffs’ geographic market definition, one of the bases for claims brought under the Sherman Antitrust …
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