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Insurance Health Antitrust & Trade Regulation

Read Insurance Law updates, alerts, news, and legal analysis from leading lawyers and law firms:

Pennsylvania Vision Insurer Accused of Anticompetitive Conduct

by Baker Donelson on

A group of independent Pennsylvania optometrists and ophthalmologists recently filed a proposed class action antitrust case against vision insurer Davis Vision, alleging that Davis Vision's in-network contractual provisions...more

10th Circuit Affirms Dismissal of Antitrust Case Against Health Insurer

by Baker Ober Health Law on

On May 31, the Tenth Circuit Court of Appeals affirmed the dismissal of plaintiff's claims in Bristow Endeavor Healthcare v. Blue Cross Blue Shield Association et al., handing Blue Cross Blue Shield of Oklahoma, and its...more

Seventh Circuit Affirms Grant of Summary Judgment in Hospital Antitrust Case

by King & Spalding on

On June 9, 2017, the United States Court of Appeals for the Seventh Circuit affirmed the lower court’s grant of summary judgment in Methodist Health Services Corp. v. OSF Healthcare System d/b/a Saint Francis Medical Center,...more

Antitrust Challenge to Narrow Network Products – 7th Circuit Rules in Favor of Exclusive Agreement

by Ruder Ware on

The health care market has recently seen a resurgence in narrow network products. To a significant degree, the resurgence of these products has been driven by the need for managed care plans looking for new avenues to help...more

Seventh Circuit OKs Exclusive Network Agreements Between “Must-Have” Hospital and Health Insurers

by Mintz Levin on

In an opinion written by Judge Posner, the Seventh Circuit on Friday gave its stamp of approval to a “must-have” hospital’s bargaining to exclude competitors from certain narrow-network payor contracts in and around Peoria,...more

The North Carolina Business Court Hands Down An Important Healthcare Antitrust Decision, Part 2

by Ellis & Winters LLP on

In a recent blog post, we discussed a new antitrust decision from the North Carolina Business Court that involves healthcare providers and health insurers. In that post, we examined the significance of that opinion to...more

Can Purchasing Efficiencies Save Mega-Mergers? The D.C. Circuit Says “No”

by Proskauer Rose LLP on

Efficiencies, economies of scale, and the general desire to improve the customer experience are the lifeblood of all mergers. And one of the most common efficiencies in any deal comes from enhanced purchasing power, or the...more

Anthem Loses Merger Appeal in a 2-1 Decision by the D.C. Circuit

by Baker Ober Health Law on

On March 24, the D.C. Circuit held oral argument on Anthem's appeal in United States v. Anthem, in which Anthem sought to have the appellate court overturn District Court Judge Amy Berman Jackson's ruling that barred the...more

Bill to Eliminate Health Insurers' Antitrust Exemption Passes in the House

by Baker Ober Health Law on

On March 22, the House of Representatives passed H.R. 372, the "Competitive Health Insurance Reform Act of 2017," by a vote of 416-7. The legislation would repeal the antitrust exemption that the health insurance industry...more

Blues Defeat Antitrust Claim by Heart Monitoring Device Maker

by Baker Ober Health Law on

On April 3, Judge Eduardo Robreno, District Judge for the Eastern District of Pennsylvania, granted judgment to a collection of insurer defendants in an antitrust conspiracy case brought against them by heart monitoring...more

House Overwhelmingly Approves Insurance Antitrust Reform Legislation

by Reed Smith on

The House of Representatives has approved HR 372, the Competitive Health Insurance Reform Act of 2017, which would repeal the antitrust exemption for health insurance companies provided under the McCarran-Ferguson Act...more

Healthcare Law Update: March 2017

by Holland & Knight LLP on

Enforcement - OIG Issues Advisory Opinion Allowing Free or Reduced-Cost Lodging and Meals - On March 3, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG) issued...more

House Judiciary Committee Advances Medical Liability, Insurance Antitrust Reform Bills

by Reed Smith on

The House Judiciary Committee has approved HR 1215, the “Protecting Access to Care Act of 2017.” The bill includes a variety of medical liability reforms, including a $250,000 cap on noneconomic damages, limits on contingency...more

Hearing Held on McCarran Repeal Legislation

by Baker Ober Health Law on

On February 16, the House Judiciary Subcommittee on Regulatory Reform, Commercial and Antitrust Law held a hearing to consider H.R. 372, the "Competitive Health Insurance Reform Act of 2017." The legislation, introduced by...more

DOJ Successfully Blocks Insurance Mergers: What Are the Takeaways?

In July 2016, following a lengthy review, the Antitrust Division of the Department of Justice (DOJ), together with several states, sued to block two proposed health insurer mergers: Aetna/Humana and Anthem/Cigna. On January...more

A tale of two mergers: Following their losses in DOJ merger challenges, Anthem fights on and Aetna gives up

In the past month, the DOJ and several state governments scored two trial wins in their challenges to mergers among some of the country’s largest health insurers. First, Judge Bates of the District of Columbia blocked the...more

Marketplace Shockwaves: Insurer Exits Leave Marketplaces Vulnerable

by Kiesewetter Law Firm on

Early this month, Aetna announced that in 2018, it will not expand its Health Insurance Marketplace ("Marketplace" or "Exchange") coverage, and is evaluating whether it will completely pull out of the Marketplaces created by...more

"DOJ Continues Streak of Successful Merger Challenges With Blocked Aetna-Humana, Anthem-Cigna Deals"

In a continuation of recent Department of Justice (DOJ) successes challenging mergers, the U.S. District Court for the District of Columbia recently enjoined two more proposed mergers brought and litigated under the Obama...more

REDIAL: 2016 TCPA Year In Review – Analysis of Critical Issues and Trends

The Sutherland TCPA team has published its third annual REDIAL: 2016 TCPA YEAR IN REVIEW – ANALYSIS OF CRITICAL ISSUES AND TRENDS. This publication reflects our in-depth analysis of significant Telephone Consumer...more

Anthem and Aetna Merger Trials Begin

by Baker Donelson on

While the election of Donald Trump as the nation's next president is clearly the biggest news in Washington over the last two months, for the insurance industry, big news has also been made at the federal district courthouse....more

Aetna and Humana Go to Battle With Regulators Over Multi-Billion Dollar Merger

The trial over Aetna and Humana's $37 billion proposed merger kicked off today in a Washington, D.C. federal court. At issue is whether the companies' merger would substantially lessen competition in the market for...more

Anthem and Aetna Prepare for Merger Trials Against the DOJ Antitrust Division

by Baker Donelson on

In late July, the DOJ Antitrust Division filed actions in federal district court seeking to derail both the Anthem/Cigna and Aetna/Humana mergers. In each case, the DOJ contended that consumers would face higher insurance...more

Big Summary Judgment Win for Hospital Defending $300M Exclusive Dealing Antitrust Suit

by Mintz Levin on

After fending off a motion for judgment on the pleadings in March 2015, a small hospital in Peoria, Illinois lost on summary judgment in its $300 million antitrust suit alleging illegal exclusive dealing and attempted...more

Compounding Pharmacy’s Group Boycott Claim Survives Motion to Dismiss

On August 23, 2016, the District Court for the Eastern District of Missouri allowed claims by a compounding pharmacy to proceed, denying a motion to dismiss filed by the defendant pharmacy benefit manager (“PBM”). In...more

Mega-Mergers Highlight Risk to Health Care Providers

by Polsinelli on

Consolidation in health insurance markets can injure hospitals and doctors by creating buyer-side market power that can force providers to accept below-market prices, limit patients’ access to care, and reduce innovation in...more

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