DOJ sues OhioHealth over hospital contract clauses alleged to raise patient costs
DOJ files antitrust case against dominant Ohio hospital system
Federal prosecutors, joined by the Ohio attorney general, brought a civil antitrust lawsuit in federal court targeting a large regional health system for contract language prosecutors say blocks lower-cost insurance options.
The complaint argues that contract provisions have constrained how commercial insurers design plans, reducing consumers’ access to cheaper alternatives and limiting employers’ ability to secure lower premiums.
Investigators point to the system’s regional heft — roughly a 40% market share in its service area — and to negotiated payment rates they say are about 50% higher than competing providers, figures used to support the claim of market power.
Officials say the probe has proceeded for multiple years and sits alongside similar reviews of large hospital systems nationwide, signaling a broader enforcement focus on insurer–provider contracting tactics.
Past enforcement offers a template: previous litigation produced settlements and contract changes after regulators challenged steering and network restrictions at other health systems.
Immediate remedies sought could include court orders to remove or change restrictive clauses, which would allow insurers to create more limited or lower-cost networks and could quickly affect premiums and out-of-pocket costs.
For the targeted health system, exposure includes legal fees, potential injunctive relief, and pressure to renegotiate longstanding agreements—an operational and reputational stress test.
Employers and insurers stand to gain bargaining leverage if the court curtails the challenged contract language, possibly prompting faster adoption of narrower, value-focused networks.
More broadly, the suit signals to dominant hospitals that contract clauses used to preserve patient flow may draw legal risk, and it could accelerate nationwide scrutiny of similar practices.
Next steps: litigation in federal court, possible discovery into contracting details, and either a negotiated settlement or a trial that could reshape how hospital–insurer deals are written.
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