News & Analysis as of

Health Insurance Dept. of Justice

The Enforcement Risks for Medicare Advantage Plans Continue: A New False Claims Act Settlement in Florida

Recent activities of the Department of Justice (“DOJ”) and Qui Tam whistleblowers reveal that Medicare Advantage Plans remain at the forefront of investigations for violations of the federal False Claim Act (“FCA”) for...more

Anthem Terminates $54 Billion Cigna Merger after Delaware Chancery Court Denies Injunction

by King & Spalding on

Anthem announced on Friday, May 12, 2017 that it delivered formal notice to Cigna of termination of the parties’ merger agreement. The announcement comes on the heels of a Delaware Chancery judge’s denial, issued late...more

Medicare Advantage Plans Under Fire: The Department of Justice Files Complaints-in-Intervention

As reported in earlier blogs, the federal Department of Justice (DOJ) has been actively looking into potential abuses by Medicare Advantage (MA) Organizations as to allegedly improper risk adjustment claims submissions and...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

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

by 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

DOJ Anti-Steering Suit Against Carolinas Healthcare Survives Preliminary Motion

by Mintz Levin on

On March 30, 2017, in a closely watched case, a federal district court denied the Motion for Judgment on the Pleadings filed by Carolinas Healthcare against the DOJ Antitrust Division and State of North Carolina’s Complaint...more

Window On Washington - This Week in the Nation's Capital

by Clark Hill PLC on

Budget Work Stymied: With the House and Senate headed for a mid-April recess, work on completing the Fiscal Year 2017 appropriations for 10 of the 11 appropriations bills remains unfinished despite an approaching April 28th...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

Health Update - February 2017

Securing the Safety Net for America's Vulnerable Populations - Editor's Note: America's population is aging rapidly. By 2029, 75 million baby boomers will have reached age 65 and older, and older adults will represent...more

Federal Court Blocks Anthem - Cigna Merger; King & Spalding Looks Deeper into Aetna-Humana Challenge

by King & Spalding on

On February 8, 2017, the United States District Court for the District of Columbia granted a request filed by the U.S. Department of Justice’s Antitrust Division for an injunction blocking Anthem, Inc.’s (Anthem) proposed $54...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

"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

DOJ Wins Again, Blocks Anthem/Cigna Merger

by King & Spalding on

On February 8, 2017, the United States District Court for the District of Columbia granted the Department of Justice, Antitrust Division’s (the “DOJ”) request for an injunction blocking Anthem’s proposed $54 billion...more

Aetna-Humana Merger Blocked

by Pierce Atwood LLP on

The District of Columbia federal court recently ruled that a proposed $37 billion merger between health insurance giants Aetna and Humana cannot proceed, granting the US Department of Justice’s bid to block the combination on...more

The AHA’s Letter to Santa Claus

The American Hospital Association, after having been “nice” all year, penned its letter to Santa Claus with its wish list for Christmas. Its four page letter (actually addressed to President-Elect Donald Trump at 1717...more

Protecting Large, National Customers in Merger Enforcement—A Temporary Trend?

by Perkins Coie on

The past year has seen some significant and interesting challenges brought by the federal antitrust agencies in the merger space. There has been evidence for years of the agencies’ aggressive willingness to litigate. And...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

Employment Law 2016 Review

by Barley Snyder on

Preparing for Medical Marijuana in Pennsylvania - Marijuana legalization reached Pennsylvania in 2016, bringing with it a host of new questions employers are going to have to answer. Signed into law on April 17, the...more

Judge Rejects Joint Defense Privilege Claim; Orders Would-be Merger Partners to Produce Sensitive Emails to DOJ

by K&L Gates LLP on

On October 14, 2016, a federal judge in Washington, D.C., ruled that two companies could not claim a joint defense privilege for certain sensitive emails they had exchanged in connection with their proposed merger. ...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

Trial Challenging Proposed Anthem, Cigna Merger Is Underway

by King & Spalding on

On November 21, 2016, the U.S. District Court for the District of Columbia heard opening arguments in the Department of Justice’s lawsuit challenging the proposed merger between Anthem, Inc. and Cigna Corporation. This is...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

DOJ-AmEx Case Could Have Ramifications for Health Care Providers

by 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

Antitrust-Related Recent Developments: FTC/DOJ Aggressive Merger Enforcement Continues

The Federal Trade Commission and Department of Justice have continued their aggressive stance against proposed mergers that the antitrust agencies perceive as harmful to competition. So far this year, the FTC obtained a...more

DOJ and States Challenge Health Insurer Mergers

by Baker Donelson on

Following more than a year of regulatory review, in late July 2016 the Department of Justice (DOJ) Antitrust Division and a number of states filed actions seeking to derail both the Anthem/Cigna and Aetna/Humana mergers. In...more

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