On Tuesday, June 4, 2024, the 9th U.S. Circuit Court of Appeals overturned Sutter Health’s win in a $411 million antitrust suit, saying that the jury that found in favor of Sutter in 2022 was given improper jury instructions, and that the plaintiffs were improperly prevented from presenting relevant evidence. In September 2012, a class of individuals and employers who purchased fully insured plans from the five largest commercial health insurance companies in California filed this lawsuit alleging that Sutter Health restricted competition in the healthcare market using anticompetitive tactics. A similar lawsuit, …

Healthcare System Mergers and Investments Private Equity-Acquired Physician Practices and Market Penetration Increased Substantially, 2012-21 (Health Affairs) Ola Abdelhadi, Brent D. Fulton, Laura Alexander, and Richard M. Scheffler The awareness for private equity’s influence on the healthcare sector continues to grow and be quantified. Generally, there has been concern among parties in the health care system regarding the rate at which private equity firms have been acquiring physician practices, creating antitrust, quality, and pricing concerns within the broader health system. A new Health Affairs study estimated the local market share …

The preponderance of research evidence demonstrates that a lack of meaningful healthcare market competition is bad for consumers – resulting in higher prices, and insurance premiums, without a commensurate increase in quality of care.  New merger guidelines issued in 2023 by the Federal Trade Commission and Department of Justice are just one indication that the Federal government is more closely examining proposed health system mergers.  Increased regulatory scrutiny, among other factors, appears to be causing a slow-down in healthcare merger activity. In addition to merger challenges by state and federal …

Private equity investment in health care across the country has continued to garner the attention of health policy researchers and policymakers in recent years. Stakeholders are concerned that private equity ownership of physician practices prioritizes profit over patient care quality. Despite concerns of potential impacts on price and quality arising from  these private equity transactions in the health care industry, few enforcement actions have occurred. Last month, the Federal Trade Commission (FTC) took the lead in challenging one of these arrangements, suing a private equity firm retroactively in federal court …

See UFCW & Employers Benefit Trust v. Sutter Health case page.   Today, California Attorney General Xavier Becerra announced the settlement terms for the landmark antitrust case, UFCW & Employers Benefit Trust v. Sutter Health. Sutter Health was alleged to engage in anticompetitive behavior by requiring “all or nothing” contracts, preventing insurance companies from providing tiered health plans, setting extremely high out-of-network rates, and restricting price transparency of provider cost information and rates. As Source Executive Editor Jaime King explains in a Tradeoffs episode, The Train Has Left the Station, …

See UFCW & Employers Benefit Trust v. Sutter Health case page.   As part of the Case Watch series for the landmark antitrust suit against Sutter Health, this post takes a look back at the Superior Court of San Francisco’s orders from March and June 2019, denying Sutter’s motions for summary judgment, which set the stage for the jury trial, set to begin on Thursday, October 10, 2019. As a preview of the legal arguments we will see at trial, we dissect each of the four causes of action brought against Sutter …

February has been a busy month for state attorneys general from coast to coast, as AGs from Pennsylvania and California assert their authorities to regulate transactions in the healthcare provider market. On the drug pricing front, we follow up on the latest action in the nationwide litigation against the now infamous generic drug price fixing scheme that, fueled by increased media attention, has rallied state, federal, and private forces across the country.   Pennsylvania AG Sues Payer-Provider for Restrictive Network Access     In an effort to regulate Pennsylvania’s provider and …