See “Anticompetitive Conduct” under Major Cases of the Litigation Portal for complete list of the latest and pending cases.

United States of America v. The New York and Presbyterian Hospital (Case 1:26-cv-02480)

• Contract Clauses Used: Most-Favored-Nation, All-or-Nothing, Anti-tiering/Anti-steering
• Complaint: Filed March 26, 2026. The Department of Justice (DOJ) sued New York-Presbyterian Hospital for using anticompetitive contract terms, stating that New York-Presbyterian uses its market power to protect its margins, impede competition from rival hospitals, and prevent employers and unions from creating budget-conscious health plans. According to the complaint, NYP imposes restrictions in its contracts that prevent payors from offering plans that do not place NYP in the plan’s most-favored tier. Additionally, payors are required to include all NYP hospitals in their networks if they want to include any NYP hospital. The suit also claims NYP prevents payors from offering lower copays when patients receive care at non-NYP facilities. The DOJ claims NYP’s actions constitute violations of Section 1 of the Sherman Act, which prohibits contracts that restrain fair trade.
• Status: Pending

United States of America and State of Ohio v. Ohiohealth Corporation (Case No.: 2:26-cv-207)

• Contract Clauses Used: Most-Favored-Nation, All-or-Nothing, Anti-tiering/Anti-steering
• Complaint: Filed February 20, 2026. The Department of Justice 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 contracts included terms requiring OhioHealth to be at the most-favored level of benefits in each network, and that payers were prevented from providing patients with price information about healthcare services. The complaint alleges violations of both the federal Sherman Act and Ohio’s Valentine Act, both of which prohibit anticompetitive conduct.
• Status: Proposed Settlement Filed June 16, 2026. The terms of the settlement include that 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. Additionally, OhioHealth will not require insurers to include OhioHealth in their most-preferred tier, but OhioHealth is allowed to 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 a five-year period, 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 on the part of OhioHealth and imposes no fines, penalties, or damages against OhioHealth.

UFCW & Employers Benefit Trust v. Sutter Health (CGC 14-538451 Consolidated with Case No. CGC-18-565398)

• Contract Clauses Used: Anti-tiering/Anti-steering and All-or-nothing Clauses
• Complaint: Filed April 7, 2014. The UFCW & Employers Benefit Trust, a trust providing employee benefits to unions, and a group of self-funded employers filed a class-action lawsuit, later joined by the California AG, alleging that the unusually high cost of health care in Northern California resulted from anticompetitive conduct by Sutter Health.  The alleged anticompetitive conduct included contracting that required all-or-nothing and anti-incentive clauses, setting extremely high out-of-network rates, and restricting disclosure of provider costs to patients and payers.
• Status: Settlement Approved August 27, 2021. The settlement terms require Sutter Health to cease anticompetitive contract terms, including all-or-nothing contracts, anti-steering and anti-tiering provisions, and price secrecy or gag clauses. The settlement also requires Sutter Health to pay $575 million in compensation and legal fees.  A court-approved monitor will ensure compliance with the settlement for at least ten years.

Sidibe v. Sutter Health (Northern District of California – Case No. 3:12-CV-04854; Appellate Court: Ninth Circuit Case No. 14-16234; Case No. 22-15634)

• Contract Clauses Used: Anti-tiering/Anti-steering and All-or-nothing Clauses
• Complaint: Filed September 2012. The plaintiffs, purchasers of commercial health insurance from certain health plans that contracted with Sutter, claim they paid inflated premiums, co-pays, and other charges as a result of Sutter’s anticompetitive conduct. First, Sutter included “all-or-nothing” clauses in its contracts that required plans to contract for all of Sutter’s services if it were to buy any of those services. Second, the plaintiffs alleged that Sutter used a second anticompetitive contractual strategy called an “anti-steering” clause, which prevented health plans from encouraging their members to seek care from other lower-cost, in-network providers.
• Status: Settlement Filed March 2, 2025. The settlement requires Sutter to pay $228.5 million into a settlement fund, but includes no new injunctive, since Sutter already agreed to adopt reforms aimed at curbing anti-competitive practices as part of the above case settlement.

United States and the State of North Carolina v. The Charlotte-Mecklenburg Hospital Authority, d/b/a Carolinas Healthcare System (Atrium Health) (Case No. 3:16-cv-00311)

• Contract Clauses Used: Anti-tiering/Anti-steering Clauses
• Complaint: Filed June 9, 2016. The DOJ and North Carolina AG filed a civil suit alleging that the provider uses anticompetitive, illegal anti-steering clauses in its contracts with insurers, which prohibit commercial health insurers in the Charlotte area from offering patients financial benefits to use less-expensive healthcare services offered by CHS’s competitors.
• Status: Final Judgement April 24, 2019. The court approved a settlement which prohibits Atrium from using anticompetitive steering restrictions in contracts with insurers or require that Atrium facilities by included in the most-preferred tier of benefit plans.

United States and the State of Michigan v. Blue Cross Blue Shield of Michigan (Case No. 2:10-cv-15155-DPH-MKM)

• Contract Clauses Used: Most Favored Nation Clauses
• Complaint: Filed Oct 18, 2010. The DOJ and the Michigan AG filed a civil suit alleging BCBS of Michigan used MFN clauses to unreasonably restrain trade in violation of Section 1 of the Sherman Act and Section 2 of the Michigan Antitrust Reform Act.  The DOJ alleges the use of MFNs by BCBS reduced the ability of other health insurers to compete with Blue Cross and raised prices paid by Blue Cross’ competitors and by self-insured employers.
• Status: Settlement Filed March 25, 2013. After Michigan passed laws prohibiting the use of MFNs in insurance contracts with providers, the parties agreed that the injunctive relief sought was unnecessary and dropped the lawsuit.

With support from Arnold Ventures, this collaboration between The Source on Healthcare Price and Competition and the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare leverages the latest and most comprehensive data on state laws, healthcare markets, and healthcare prices and quality to determine the most efficient and successful policy levers. This collaborative series will analyze the variation in state laws and subsequent economic impacts in the last ten years (2008-2018), as well as more recent legislative trends to develop recommendations and strategies for states with varied resources and political environments.

                       

If you would like to report a possible data discrepancy, please email info@sourceonhealthcare.org or contact The Source here. *Disclaimer: No information presented here is intended to be legal advice. The court cases presented here are illustrative examples in which the court applied a standard for public harm or another standard unique to health care practitioners. Anyone seeking legal advice about the enforceability of specific noncompete provisions should consult with an attorney licensed in their state.