In the first challenge against anticompetitive unilateral conduct since 1999, the Department of Justice reached a proposed settlement with a Texas hospital to enjoin it from entering into exclusionary contracts that effectively prevented commercial health insurers from also contracting with the hospital's rivals.

In U.S. v. United Regional Healthcare System, case number 7:11-cv-00030, filed in the U.S. District Court for the Northern District of Texas on February 25, 2011, the DOJ (in conjunction with the Texas Attorney General) alleges that United Regional's maintenance of its monopoly over hospital services in the Wichita Falls area violated Section 2 of the Sherman Act.

Specifically, the complaint alleges that United Regional has approximately 90% of the market for inpatient hospital services, and a greater than 65% share of the market for outpatient surgical services, sold to commercial insurers in the relevant geographical market. By far the largest hospital in the region and the only provider of some essential services, United Regional is considered by insurers a "must have" hospital for inclusion in their networks.