DOJ Antitrust Settlements Target Hospital Steering Restrictions in Commercial Payer Contracts
The U.S. Department of Justice Antitrust Division filed civil complaints against hospital systems for using contract provisions that require health insurers to include them in nearly all commercial networks at preferred benefit tiers. These steering restrictions limit insurers' ability to design narrow network products. The OhioHealth settlement reflects DOJ's increased enforcement focus on payer contracting practices that constrain network design flexibility. While the cases involve commercial insurance, the enforcement trend signals heightened scrutiny of similar anti-steering and anti-tiering provisions that may appear in Medicaid managed care contracts.
Medicaid MCOs using similar anti-steering or most-favored-status clauses in provider contracts face increased antitrust enforcement risk and potential state regulatory review of network adequacy versus competitive contracting practices.
Managed Care
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