Antitrust and Market Competition Playing Favorites — State Protection of Academic Medical Centers from Antitrust Oversight New England Journal of Medicine Jaime S. King, Katherine L. Gudiksen, Anna D. Sinaiko The authors explore a new trend with U.S. academic medical centers (AMCs) merging with nonacademic hospitals and health care systems.  These mergers pose risks of price increases and other competitive harms.  Regulators should review all transactions involving an AMC and ensure that any promised benefits from consolidation do not harm the public.  Notably, at least four states have laws explicitly […]

Healthcare Prices and Payments UnitedHealthcare Pays Optum Providers More Than Non-Optum Providers Health Affairs Daniel R. Arnold, Brent D. Fulton Optum has a history of increasing market power through aggressive acquisitions of healthcare services and has been accused of using that market power to impede provider competition for financial gain.  UnitedHealthcare and Optum are parts of the same company, with UnitedHealthcare serving as the insurance arm, and Optum providing healthcare services.  In 2024, Optum, which includes a variety of smaller entities such as a pharmacy benefit manager (PBM) and software […]

Health Care Consolidation and System Reform Health Care Consolidation: Published Estimates of the Extent and Effects of Physician Consolidation Government Accountability Office In 2023, Congress directed the Government Accountability Office to study the extent of healthcare consolidation, the potential role of private equity, and the effects on healthcare quality, access, spending, and costs. The GAO reviewed peer-reviewed empirical studies and reports from January 2021 through July 2025, and interviewed stakeholders, including physicians, hospitals, insurers, private equity firms, retail companies, and employees. The article cited available data sources, including PECOS, insurer […]

Update – On October 11, the Governor signed AB 1415, and it was subsequently chaptered by the Secretary of State, making it California law. In May, The Source shared information about Assembly Bill 1415 and Senate Bill 351, bills introduced in February 2025 as part of the state’s ongoing efforts to regulate private equity healthcare transactions and costs.  After four amendments, AB 1415 has been enrolled and sent to Governor Newsom’s desk.  The early draft of the bill sought to cast a wide net by thoroughly expanding definitions of terms […]

Impact of Federal Hospital Policies Sharp Rise In Urban Hospitals With Rural Status In Medicare (Health Affairs) Yang Wang, Jared Perkins, Christopher Whaley, Ge Bai This article aims to quantify the impacts of Geisinger Community Medical Center v. Secretary, United States Department of Health and Human Services, and Lawrence Memorial Hospital v. Burwell, which began allowing hospitals to qualify for both urban wage indexes for calculating Medicare reimbursements and Medicaid rural health policies designed to support rural healthcare.  The authors assess changes by tracking the proportions of administratively and geographically rural and […]

Rural Healthcare Access Rural Hospital Closures Led to Increased Prices at Nearby ‘Surviving’ Hospitals, 2012-22 (Health Affairs) Caitlin Carrol, Jessica Chang Research on how consolidation affects healthcare pricing largely centers on mergers rather than closures. Hospital closures, especially those in rural areas, reallocate patient populations to nearby ‘surviving’ hospitals posing distinct effects on the remaining healthcare market. In theory, reallocation of a patient population can increase production efficiencies and lower costs at the remaining hospital, resulting in savings that could be passed to consumers in the form of lower prices. […]

The 2025–2026 legislative session has produced two major regulatory oversight bills regarding private equity in healthcare. SB 351, introduced by Senator Christopher Cabaldon (D) on February 12, 2025, and currently set for its second hearing, focuses on strengthening California’s ban on the corporate practice of medicine. Similarly, AB 1415, authored by Assemblymember Mia Bonta (D), seeks to expand the authority granted to the Office of Health Care Affordability (OHCA) in monitoring healthcare transactions. Below we discuss the intricacies of each bill, the potential impact on the state’s healthcare market, and […]

Healthcare Consolidation Partnerships Between Pharmaceutical and Telehealth Companies – Increasing Access or Driving Inappropriate Prescribing? (The New England Journal of Medicine) Erin C. Fuse Brown, Oliver J. Wouters, Attev Mehrotra As technology has progressed, so too have health care delivery mechanisms for Americans. However, an emerging collaboration between pharmaceutical companies, like Pfizer and Eli Lilly, and telehealth companies is leaving many divided. Pharmaceutical companies have evolved their marketing and disbursement practices by increasingly using social media marketing to now directly link to telehealth providers who connect healthcare consumers with a […]

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 […]

Private Equity in Healthcare The Rise of Private Equity in Health Care  — Not a Uniquely American Phenomenon (The New England Journal of Medicine) Yashaswini Singh, Erin Fuse Brown, and Irene Papanicolas Private equity investment in the United States has become an increasingly hot topic – with many debating whether the industry’s prioritization of short-term profitability over long-term investments make it an appropriate fit for patient care. While the issue of private investment in healthcare may appear to many to be a uniquely American phenomenon, given this country’s market-based system, […]