More States Sue Healthcare Companies for Inflating Costs on Americans: A Wave of Antitrust Enforcement
In 2026, a powerful wave of litigation is sweeping across the United States as state attorneys general and the Department of Justice (DOJ) aggressively target healthcare companies accused of inflating costs on American patients and employers. From hospital systems using restrictive contracts to generic drug manufacturers conspiring to fix prices, the message is clear: antitrust enforcers are putting healthcare affordability at the top of their agenda.
This comprehensive guide examines the recent lawsuits, the legal theories behind them, and what these developments mean for employers and patients.
The DOJ’s Renewed Focus on Healthcare Antitrust Enforcement
According to remarks delivered by Deputy Assistant Attorney General Nicole Sarrine at the Transparency Rising 2026 National Forum, the Antitrust Division is “more focused than ever on affordability issues” in healthcare[citation:4].
Sarrine emphasized that the rising cost of healthcare risks broad harm across the economy, noting that over the past 25 years, “the cost of employer-provided family health insurance coverage has grown three times faster than workers’ earnings”[citation:4]. Rising premiums disproportionately burden small businesses, which “typically spend more per employee on health insurance than larger businesses”[citation:4].
As Sarrine stated: “Under President Trump, the Antitrust Division is squarely focused on the challenges in healthcare markets and how antitrust enforcement has the potential to improve consumer choice and affordability in those markets”[citation:4].
This focus has translated into concrete action. In the first quarter of 2026 alone, the DOJ filed two major civil antitrust lawsuits against prominent hospital systems, with more expected to follow.
Case #1: OhioHealth – Anti-Steering Provisions in Columbus
On February 20, 2026, the DOJ and the Ohio Attorney General filed a civil action against OhioHealth Corporation, alleging violations of federal and state antitrust laws through restrictive contracts and anti-steering practices[citation:1].
According to the complaint, OhioHealth has market power in the provision of inpatient general acute care hospital services in the Columbus, Ohio market. The health system allegedly used its position to restrict the ability of commercial insurers to design and offer lower-cost health plans[citation:1][citation:2].
The DOJ and Ohio AG allege that OhioHealth restricted competition with rival hospitals through a variety of contractual provisions, including:
- Anti-steering provisions that prevent insurers from directing patients to lower-cost providers
- Limitations on price transparency that gag insurers from sharing cost information with patients
- All-or-nothing contracting terms requiring insurers to include all OhioHealth hospitals in their networks and provide them with the highest benefit tier[citation:1]
The complaint further alleges that OhioHealth’s network contains rural hospitals that insurers “must include in their networks to maintain coverage, which limits payors’ ability to effectively negotiate with OhioHealth”[citation:1]. As a result, these restrictions prevent lower-cost healthcare providers from gaining patient volume and achieving the scale required to compete effectively.
According to Duane Morris analysis, the DOJ alleges that OhioHealth collects “higher reimbursement rates from insurers than surrounding hospitals, despite offering similar or lower quality care”[citation:2].
Case #2: NewYork-Presbyterian – Mirroring the OhioPlaybook
Just over a month later, on March 26, 2026, the DOJ filed a civil antitrust lawsuit against NewYork-Presbyterian Hospital (NYP), alleging similar anticompetitive contract restrictions[citation:3][citation:9].
According to Freshfields analysis, NYP is the largest and most powerful hospital system in New York City, owning and operating eight hospitals and many outpatient facilities. DOJ alleges that NYP commands a market share of 30% in Manhattan and more than 25% in the four-borough area[citation:3].
The complaint alleges that NYP uses its relative size to restrict the ability of commercial health insurers to design and offer lower-cost health plans through:
- Requirements that NYP be included in almost all networks for commercial insurance products
- Requirements that NYP be featured at the most favored level of benefits in each plan
- Restrictions preventing insurers from offering lower copays when patients choose NYP’s often lower-priced rivals[citation:3][citation:9]
As Attorney General Pamela Bondi stated: “Millions of New Yorkers pay more for healthcare because of these anticompetitive practices. At the direction of President Trump, this Justice Department will fight relentlessly to ensure that Americans get the healthcare they need without facing exorbitant costs”[citation:9].
Acting Assistant Attorney General Omeed A. Assefi added: “NewYork-Presbyterian has known for years that the American consumer wants budget-conscious health plans that reduce healthcare costs. But rather than offer consumers choice, NewYork-Presbyterian uses its market power to protect its margins”[citation:9].
Case #3: MultiPlan – The Price-Fixing Data Firm
Beyond hospital systems, states are also targeting data firms and insurers accused of conspiring to suppress payments. According to the Texas Medical Association (TMA), a federal multidistrict litigation is underway against MultiPlan (recently rebranded to Claritev) and major insurers, including UnitedHealth, Elevance, Humana, Aetna, and Cigna[citation:5].
The lawsuit alleges that these companies conspired to systematically underpay healthcare practitioners for out-of-network services, with payments that “often fail to even cover operating costs”[citation:5]. MultiPlan processes more than 80% of all commercial out-of-network reimbursement claims in the United States[citation:5].
The Medical Society of the State of New York reports that the litigation has made significant progress, with the Department of Justice filing a statement of interest in March 2025 and the court denying defendants’ motion to dismiss in June 2025, allowing the case to proceed to discovery[citation:10].
MultiPlan goes by many names, including Data iSight, Viant, NCN, ProPricer, and MARS. Physicians and providers may not always know whether MultiPlan re-priced their claims, but clues can often be found in Explanations of Benefits or remittance advice[citation:5][citation:10].
Case #4: Generic Drug Price-Fixing Conspiracy
On February 2, 2026, Idaho Attorney General Labrador joined a coalition of 48 states and territories announcing settlements with Lannett Company and Bausch Health, totaling $17.85 million[citation:6].
These settlements resolve allegations that both companies engaged in “widespread, long-running conspiracies to artificially inflate and manipulate prices, reduce competition, and unreasonably restrain trade for numerous generic prescription drugs”[citation:6].
The Lannett and Bausch settlements follow prior settlements with Apotex and Heritage, which totaled $49.1 million. As part of their settlement agreements, both companies have agreed to cooperate in the ongoing multistate litigations against 30 corporate defendants and 25 individual executives[citation:6].
The cases stem from investigations built on “a massive document database of over 20 million documents, and a phone records database containing millions of call records and contact information for over 600 sales and pricing individuals in the generic drug industry”[citation:6]. The complaints describe how defendants used terms like “fair share,” “playing nice in the sandbox,” and “responsible competitor” to describe how they unlawfully discouraged competition.
What This Means for Employers and Patients
The wave of antitrust enforcement has significant implications for employers who sponsor health plans and employees who pay premiums.
For Employers
The DOJ’s complaints specifically identify the types of “budget-conscious plans” that hospital systems are allegedly blocking, including:
- Tiered plans that charge less when patients use cost-effective providers
- Center of excellence plans that reward patients for choosing high-value providers
- Narrow network plans that exclude high-cost hospitals in exchange for lower premiums
- Site of service steering that encourages patients to choose ambulatory surgery centers over hospitals
- Reference-based pricing that ties reimbursement to market averages[citation:2]
If the DOJ succeeds in these cases, employers may gain access to more innovative, cost-saving plan designs that have been unavailable in markets dominated by powerful hospital systems.
Learn more about conducting a benefits audit to identify opportunities for cost savings in your health plans.
For Patients
According to McKnight’s Long-Term Care News, the DOJ’s actions are designed to lower healthcare costs for patients by eliminating anticompetitive practices that keep prices artificially high[citation:8]. However, the same analysis warns that subacute care settings may face downstream financial pressures as hospitals respond to litigation.
If you paid for certain generic prescription drugs between May 1, 2009 and December 31, 2019, you may be eligible for compensation through the generic drug price-fixing settlements. Idahoans and residents of participating states can call 1-866-290-0182 or visit www.AGGenericDrugs.com[citation:6].
The Bigger Picture: A Coordinated Enforcement Strategy
The DOJ’s lawsuits share common themes that signal a coordinated enforcement strategy:
- All-or-nothing contracting: Both OhioHealth and NYP allegedly require insurers to include all their facilities in-network, preventing selective contracting with lower-cost rivals.
- Most-favored-tier provisions: Both systems require placement in the highest benefit tier, eliminating price competition.
- Anti-steering provisions: Both restrict insurers from directing patients to lower-cost alternatives.
- Price transparency limitations: OhioHealth allegedly imposed gag rules preventing insurers from sharing cost information with patients[citation:1][citation:2][citation:3].
As Deputy Assistant Attorney General Sarrine explained, these restrictions “even impose a gag rule preventing insurers from providing patients with truthful information about the prices of healthcare services they may receive. This deprives patients of meaningful choice and shields dominant, high-cost hospital systems from competition”[citation:4].
The DOJ has signaled that these cases are just the beginning. As the Freshfields analysis concludes: “The NYP action suggests that DOJ’s renewed civil conduct enforcement push in healthcare is likely to continue, with more significant providers facing heightened scrutiny of contracting terms that may limit insurer flexibility”[citation:3].
For a quick assessment of your benefits strategy, take this free 5-question mental health check.
Conclusion: A Turning Point for Healthcare Affordability
The wave of litigation against healthcare companies accused of inflating costs represents a turning point in the fight for healthcare affordability. With the DOJ filing two major hospital antitrust cases in early 2026, states securing settlements in generic drug price-fixing conspiracies, and the MultiPlan litigation advancing toward trial, the message is clear: antitrust enforcers are putting healthcare at the top of their agenda.
For employers and patients who have long felt powerless against rising healthcare costs, these lawsuits offer hope that competition—not consolidation—will drive down prices and improve quality.
Please note: This blog is for informational purposes only and is not a substitute for professional legal advice. Always consult with qualified legal counsel regarding antitrust compliance.
Key Takeaways
- The DOJ and Ohio AG sued OhioHealth on February 20, 2026, alleging anti-steering provisions, all-or-nothing contracting, and price transparency limitations that inflate healthcare costs in Columbus[citation:1]
- The DOJ sued NewYork-Presbyterian Hospital on March 26, 2026, alleging similar anticompetitive contract restrictions that harm New Yorkers[citation:3][citation:9]
- MultiPlan (now Claritev) and major insurers face federal antitrust litigation for allegedly conspiring to underpay out-of-network providers, with DOJ filing a statement of interest in support[citation:5][citation:10]
- 48 states and territories secured $17.85 million in settlements with Lannett and Bausch for generic drug price-fixing, following prior settlements totaling $49.1 million[citation:6]
- Over the past 25 years, family health insurance premiums have grown three times faster than workers’ earnings[citation:4]
- Small businesses “typically spend more per employee on health insurance than larger businesses”[citation:4]
- MultiPlan processes more than 80% of all commercial out-of-network reimbursement claims in the United States[citation:5]
- OhioHealth collects “higher reimbursement rates from insurers than surrounding hospitals, despite offering similar or lower quality care”[citation:2]
- Healthcare plan sponsors may gain access to more innovative plan designs (tiered networks, narrow networks, site-of-service steering) if DOJ succeeds[citation:2][citation:4]
- Consumers who paid for certain generic drugs between May 2009 and December 2019 may be eligible for compensation at www.AGGenericDrugs.com[citation:6]
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This comprehensive guide was published on May 21, 2026. Sources include the Department of Justice, Freshfields, Duane Morris, Texas Medical Association, Medical Society of the State of New York, Idaho Attorney General’s Office, and McKnight’s Long-Term Care News.
