News & Analysis as of

Anti-Competitive Health Insurance

Goodwin

Reliance on Third-Party “Pricing” Facilitators Under Increasing Antitrust Scrutiny

Goodwin on

In the past year, healthcare systems and providers across the country have filed a series of antitrust lawsuits against MultiPlan Inc. and major US health insurers, alleging a hub-and-spoke conspiracy to fix and reduce...more

Benesch

Dental/DSO Intelligence Monthly Report: February 2024

Benesch on

Conceived and founded by 16 doctors, EPIC4 is a unique entity—a Specialty Partnership Organization where dental specialists can maximize potential at all stages of their life and practice. Forming EPIC4 was something of an...more

Stevens & Lee

Federal Trade Commission Policy Paper Takes Hard Stance Against Certificates of Public Advantage

Stevens & Lee on

Background- Many states have enacted Certificate of Public Advantage (“COPA”) laws which seek to permit hospital mergers that might otherwise have been challenged by the Federal Trade Commission (“FTC”) and found to violate...more

Foley & Lardner LLP

Nevada is Latest State to Enhance Oversight of Health Care Transactions

Foley & Lardner LLP on

On October 1, 2021, Nevada will join a handful of states that are actively seeking to monitor the growth and impact of health care transactions in their states, and will also designate specific contracting practices viewed as...more

Payne & Fears

Consumer Class Action Against Sutter Health Allowed to Proceed

Payne & Fears on

A recent case in the Northern District of California presents a reminder that hospital systems need to consider antitrust issues when negotiating multi-hospital contracts with health plans. Unfortunately, even when hospitals...more

Locke Lord LLP

Eliminating McCarran-Ferguson Immunity for Health Insurers - Higher Prices and ‎Compliance Burdens

Locke Lord LLP on

For decades, politicians of both stripes routinely promised that they would do something about the relentless rise in health insurance costs by repealing the McCarran-Ferguson Act. Now that Congress passed and former...more

Akerman LLP - Health Law Rx

Klobuchar Antitrust Bill Could Have Significant Impact on Healthcare Industry

In early February, Senator Amy Klobuchar, new Chair of the Senate Judiciary Subcommittee on Antitrust, Competition Policy and Consumer Rights, introduced the “Competition and Antitrust Law Enforcement Reform Act of...more

Akin Gump Strauss Hauer & Feld LLP

Competitive Health Insurance Reform Act Signed Into Law, Repeals More Than Half-Century-Old Antitrust Exemption for US Health...

Key Points - Until recently, the McCarran-Ferguson Act of 1954 made the “business of insurance,” including the business of health insurance, immune from federal antitrust laws. - The Competitive Health Insurance Reform...more

Cozen O'Connor

Repeal of McCarran-Ferguson Act — Ramifications for Insurance Clients

Cozen O'Connor on

Health insurance companies are now no longer immune from antitrust scrutiny for activities previously found to be “the business of insurance.” Last week, the Competitive Health Insurance Reform Act (CHIRA) was enacted,...more

Health Care Compliance Association (HCCA)

Blue Cross Blue Shield nears settlement for $2.7 billion

Compliance Today (December 2020) - The Blue Cross Blue Shield insurance group has negotiated a possible settlement to sweeping antitrust lawsuits that alleged the group benefited from anticompetitive measures that...more

Manatt, Phelps & Phillips, LLP

Strategies to Expand Transparency, Enhance Competition and Control Costs

Editor’s Note: In a new toolkit prepared for the Robert Wood Johnson Foundation, summarized below, Manatt Health helps insurance regulators understand the wide range of transparency and competition strategies available to...more

Akerman LLP - Health Law Rx

Sutter Health Settles California Attorney General Antitrust Case With Cash and an Agreement to Make Significant Changes to its...

The terms of a settlement that resolved antitrust litigation between the State of California and Sutter Health, the largest health system in Northern California, have now become public, almost two months after the settlement...more

Akerman LLP - Health Law Rx

FTC Investigating the Competitive Effects of Certificates of Public Advantage

The Federal Trade Commission has issued orders to five health insurers and two health systems requiring them to provide information that will assist the FTC in studying the competitive effects of certificates of public...more

Sheppard Mullin Richter & Hampton LLP

Proposed CVS Health-Aetna Acquisition Holds Strong in Congressional Hearing

Last Tuesday, February 27, 2018, representatives of CVS Health and Aetna went before the House Judiciary Committee Subcommittee on Regulatory Reform, Commercial, and Antitrust Law (“Subcommittee”) to argue in favor of CVS...more

Holland & Knight LLP

Recent Developments in Antitrust Scrutiny of Healthcare-Provider Transactions

Holland & Knight LLP on

As the trend of acquisitions of physician practices and mergers of hospitals continues, so does antitrust scrutiny of these deals. There was activity this week in three different proposed transactions that caught the...more

Ruder Ware

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

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

Sheppard Mullin Richter & Hampton LLP

Has the Acquisition of Cigna Corp. by Anthem, Inc. Been Relegated to the Dustbin of History? Stay Tuned!

On April 28, 2017, the U.S. Court of Appeals for the D.C. Circuit upheld a February 8, 2017 decision by the U.S. District Court for the District of Columbia to block the $54 billion acquisition of Cigna Corp. by Anthem, Inc.....more

Hogan Lovells

Court Upholds DOJ Antitrust Lawsuit Challenging Carolinas HealthCare System’s Anti-Steering Provisions

Hogan Lovells on

Despite a recent decision by the Second Circuit suggesting that anti-steering contractual provisions in other industries may not be anticompetitive, DOJ’s lawsuit (United States v. Carolinas HealthCare System) against...more

Troutman Pepper

House Votes to Repeal Antitrust Exemption for Health Insurers Under the Mccarran-Ferguson Act

Troutman Pepper on

On March 22, the U.S. House of Representatives passed the Competitive Health Insurance Reform Act of 2017, which would repeal the current limited federal antitrust immunity for health insurers. The bill would amend the...more

Patterson Belknap Webb & Tyler LLP

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

Skadden, Arps, Slate, Meagher & Flom LLP

"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

Polsinelli

DOJ-AmEx Case Could Have Ramifications for Health Care Providers

Polsinelli on

The U.S. Department of Justice's loss to American Express sends a message to health care providers: Steering, tiering, exclusive dealing and other contractual arrangements that appear to suppress competition in one part of...more

King & Spalding

DOJ Sues to Block Health Plan Mergers

King & Spalding on

The U.S. Department of Justice (DOJ), joined by attorneys general from several states, filed a lawsuit last Thursday in the U.S. District Court for the District of Columbia seeking to block two major mergers between health...more

Sheppard Mullin Richter & Hampton LLP

U.S. Department of Justice Sues North Carolina Hospital System for Insisting on Anti-Steering Provisions in Insurance...

On June 9, 2016, the Antitrust Division of the United States Department of Justice (“DoJ”) filed a complaint against the Charlotte-Mecklenburg Hospital Authority, d/b/a Carolinas Health Care System (“CHS”) in the United...more

Buchalter

Aetna vs. BASM: Pigs Get Fat and Hogs Get Slaughtered

Buchalter on

On April 13, 2016, a jury in Santa Clara, California awarded Aetna, Inc. $37.4 million from Bay Area Surgical Management, LLC (“BASM”), six of its affiliated surgery centers and its three principals. Aetna had accused the...more

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