Overview
North Carolina is a state that is active in antitrust enforcement in the healthcare market. In addition to prohibiting most-favored nation clauses in provider contracts, the state is also the site of a major enforcement case that alleged anticompetitive contract practice in a lawsuit against Atrium Health (formerly Carolinas Healthcare System). Joining the Department of Justice, the North Carolina state attorney general sued the provider for using illegal anti-steering and anti-tiering clauses in its contracts with insurers, which prohibited commercial health insurers in the Charlotte area from offering patients financial benefits to use less-expensive healthcare services offered by Atrium’s competitors. The case settled when Defendants agreed to end their anticompetitive practices. Additionally, while non-compete agreements for physicians in North Carolina are not per se unenforceable, the Court of Appeals of North Carolina has recognized in several cases its potential for harm to the public health and found noncompetes unenforceable (see Aesthetic Facial & Ocular Plastic Surgery Ctr., P.A. v. Zaldivar and Calhoun v. WHA Med. Clinic, PLLC).
The North Carolina AG has also been active in enforcing merger oversight of healthcare providers in the state. State law requires prior notice to the state AG for healthcare transactions involving certain charitable or religious corporations and the written consent or court approval of the merger after review based on a criteria of public interest. In response to a wave of healthcare consolidation in North Carolina, the state repealed its certificate of public advantage law in 2015, which some argued have contributed to increased consolidation and market power in the provider market. Additionally, Attorney General Josh Stein released a statement in 2021 criticizing and expressing concerns over the potential impact of consolidation and warned of increased scrutiny of proposed mergers by the AG’s office. For example, in HCA’s acquisition of Mission Health System, the AG imposed conditions that would permit the office to take legal action under North Carolina law should HCA fail to comply with its commitments under the consent order.
North Carolina is also a national leader in value-based payment reforms. The state implemented various alternative payment initiatives in both the public and private sectors, including Medicaid managed care alternative payment models, Medicare ACOs, BCBS North Carolina ACOs, and state employee health plan reference pricing strategy. North Carolina is on track to see alternative payment models account for 70% of healthcare payments in the state.
In health care transparency, the state legislature enacted law that requires the NC Department of Health and Human Services to publish charge information relating to the most frequently reported admissions. However, the state still lacks a legislated website such as an all payer claims database to enable consumers to make side-by-side price comparisons between providers.
See below for an overview of existing North Carolina state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/11/2023 - 7/28/2023 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
H 1039 – North Carolina
Introduced: 2022 Status: Inactive / Dead
Enacts Article 11C, GS Chapter 131E, to be cited as the Medical Debt Protection Act (Act). States the Article’s legislative purpose. Includes 15 defined terms. Requires all large health care facilities (defined to include licensed …
H 107 (see companion bill S 48) – North Carolina
Introduced: 2023 Status: In Process
Repeal Certificate of Need Laws
H 1104 – North Carolina
Introduced: 2020 Status: Inactive / Dead
Access to Affordable Health Coverage for All. States legislative intent to provide a refundable premium tax credit designed to help eligible individuals in the coverage gap to afford health insurance purchased through the federal Health …
H 149 – North Carolina
Introduced: 2021 Status: Inactive / Dead
Improving Access to Care Through Telehealth. The PCS to House Bill 149 would create a new section in the Insurance Chapter of the General Statutes requiring coverage for health care services delivered through telehealth and …
H 169 – North Carolina
Introduced: 2021 Status: Inactive / Dead
State Health Plan Data Transparency. An Act allowing the North Carolina state health plan for teachers and state employees to access and utilize its own claims payment data while continuing to protect the confidentiality of …
N.C. Gen. Stat. § 143B-139.4B. Office of Rural Health to oversee and monitor establishment and administration of statewide telepsychiatry program: Department of Health and Human Services – North Carolina
Introduced: Status: Enacted
States that the North Carolina Office of Rural Health shall oversee the establishment and administration of a statewide telepsychiatry program that allows referring sites to utilize consulting providers at a consultant site to provide timely …
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N.C. Gen. Stat. § 143B-139.5C. Internet data warehouse for provider records; annual review of accrediting body policies to avoid duplication: Department of Health and Human Services – North Carolina
Introduced: Status: Enacted
States that the Secretary shall allow private sector development and implementation of an internet-based secure and consolidated data warehouse and shall review on an annual basis updates to policy made by accrediting bodies including the …
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N.C. Gen. Stat. § 58-2-240. Market conduct analysis, financial analysis, and related information not public record: Commissioner of Insurance – North Carolina
Introduced: Status: Enacted
Notwithstanding Chapter 132 of the General Statutes, all market analysis, documents arising from market conduct action, and financial statement analysis work papers are confidential, are not open for public inspection, and are not discoverable or …
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N.C. Gen. Stat. § 58-2-40. Powers and duties of Commissioner: Commissioner of Insurance – North Carolina
Introduced: Status: Enacted
Describes the powers and duties of the Commissioner of Insurance.
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N.C. Gen. Stat. § 58-3-105. Limitation of risk: General Regulations for Insurance – North Carolina
Introduced: Status: Enacted
States that no insurer doing business in the State shall expose itself to any loss on any one risk in an amount exceeding ten percent of its surplus to policyholders.
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Novant Health, Inc. and Community Health Systems, Inc., In the Matter of – North Carolina
District Court: Status: Pending
On January 25th, 2024, the Federal Trade Commission (FTC) announced that it had authorized a suit to block Novant Health’s proposed acquisition of two hospitals …
In re Mission Health Antitrust Litigation – North Carolina
District Court: Western District of North Carolina Status: Pending
Originally filed in federal district court by the city of Brevard, North Carolina (City of Brevard, North Carolina v. HCA Healthcare and Mission Health System), …
Davis et al. v. HCA Healthcare and Mission Health System – North Carolina
District Court: North Carolina Superior Court (Buncombe County) Status: Pending
The class action lawsuit filed in North Carolina state court against HCA Healthcare and Mission Health alleges anticompetitive practices in violation of the North Carolina …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
North Carolina enacts budgets on a two-year cycle, beginning July 1 of each odd-numbered year and valid through June 30 of the following odd-numbered year.
RESEARCH & ARTICLES
- North Carolina: The New Frontier For Health Care Transformation (Health Affairs)
KEY RESOURCES
- North Carolina General Assembly
- North Carolina Department of Justice
- North Carolina Department of Insurance