US Government Sues Healthcare Carriers: A New Wave of Antitrust Enforcement
In a dramatic escalation of federal antitrust enforcement, the U.S. Department of Justice (DOJ) has launched a coordinated campaign against healthcare carriers, hospital systems, and pricing intermediaries accused of anticompetitive practices that drive up healthcare costs for American patients and employers. The message from Washington is clear: antitrust enforcers are putting healthcare affordability at the top of their agenda.
This comprehensive guide examines the major lawsuits filed in 2026, the legal theories behind them, and what these developments mean for employers who sponsor self-funded health plans.
The DOJ’s Renewed Focus on Healthcare Antitrust Enforcement
In 2026, the DOJ Antitrust Division has signaled that healthcare is a top priority. According to Freshfields analysis, the lawsuits represent “the second civil conduct enforcement action following more than a year-long pause, signaling DOJ’s renewed commitment to bringing civil cases.”
Acting Assistant Attorney General Omeed Assefi has emphasized the division’s focus on “pocketbook issues” in healthcare, stating that lower healthcare prices are “exactly the kind of kitchen table priority we should be pursuing” [citation:5].
Attorney General Pamela Bondi has vowed that “this Department of Justice will continue taking legal action to protect consumers and drive down healthcare costs across America” [citation:9].
Case #1: United States v. New York-Presbyterian Hospital
On March 26, 2026, the DOJ filed a civil antitrust lawsuit against New York-Presbyterian Hospital (NYP) in the Southern District of New York, alleging violations of Section 1 of the Sherman Act [citation:1].
The Allegations
According to the complaint, NYP is the largest hospital system in Manhattan and throughout New York City, commanding a market share of 30% in Manhattan and more than 25% across four boroughs (Bronx, Brooklyn, Manhattan, and Queens) [citation:3].
The DOJ alleges that NYP uses its market power to impose restrictive contract provisions on commercial health insurers, including:
- All-or-nothing network participation: Insurers must include all NYP hospitals and facilities in their networks if they want any NYP facility [citation:5].
- Most-favored-tier requirements: NYP requires placement at the highest benefit tier in every plan, regardless of its prices compared to competitors.
- Anti-steering provisions: Contracts prohibit insurers from offering lower copays or financial incentives to encourage patients to choose lower-cost rival hospitals [citation:3].
- Restrictions on site-of-service steering: NYP has invoked contract provisions to prevent insurers from incentivizing patients to receive procedures at lower-cost ambulatory surgery centers [citation:5].
As a result of these restrictions, DOJ argues that NYP’s conduct increases healthcare costs and reduces choices for patients and employers in New York City [citation:1].
Case #2: United States v. OhioHealth Corporation
On February 20, 2026, the DOJ and the Ohio Attorney General filed a civil antitrust lawsuit against OhioHealth Corporation, the largest healthcare system in central Ohio [citation:4].
Market Dominance and Alleged Conduct
The complaint alleges that OhioHealth has market power in the sale of inpatient general acute care hospital services in the Columbus area. According to Duane Morris analysis, OhioHealth collects “higher reimbursement rates from insurers than surrounding hospitals, despite offering similar or lower quality care.”
The DOJ alleges that OhioHealth’s contracts with insurers limit the ability to offer various types of “steered plans,” including [citation:4]:
- 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
- Active transparency provisions allowing insurers to inform patients of lower-cost options
The complaint further alleges that OhioHealth imposes “gag rules” preventing insurers from providing patients with truthful information about the prices of healthcare services [citation:7]. Attorney General Bondi stated: “Americans deserve low-cost, high-quality health care — not anticompetitive hospital system contracts that make health care less affordable” [citation:7].
Case #3: MultiPlan (Claritev) Antitrust Litigation
Beyond hospital systems, the DOJ has also targeted data firms and insurers accused of conspiring to suppress out-of-network payments. According to the Medical Society of the State of New York, a federal antitrust lawsuit is currently underway against MultiPlan (recently rebranded to Claritev), a healthcare data firm, and major health insurance companies including UnitedHealth, Elevance (Anthem), Humana, Aetna, Cigna, and various Blue Cross Blue Shield entities.
MultiPlan processes more than 80% of all commercial out-of-network reimbursement claims in the United States. The lawsuit alleges that MultiPlan, using services like Data iSight, Viant, NCN, ProPricer, and MARS, facilitated a horizontal price-fixing agreement among insurers that artificially suppressed out-of-network payment rates and cost providers billions of dollars [citation:8].
The case 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 litigation to proceed to discovery [citation:8].
Case #4: Zelis Antitrust Litigation
A similar antitrust lawsuit has cleared a federal court in Massachusetts against five major health insurers—Aetna, Cigna, Elevance, Humana, and UnitedHealth—over their use of repricing technology from Zelis Healthcare LLC [citation:10].
Providers allege that Zelis’ tools forced them to accept “severely downwardly adjusted” reimbursements, with court filings showing payment amounts as low as 1% of invoiced charges [citation:10]. Zelis is compensated based on the difference between what providers charge and the amount ultimately paid—creating an incentive to minimize reimbursements.
In allowing the antitrust lawsuit to proceed, the Massachusetts court found there is a legitimate dispute over whether Zelis’ services amount to a price-fixing agreement among competitors [citation:10].
Case #5: Carolina Neurosurgery v. Multiplan, et al.
On March 6, 2026, Carolina Neurosurgery and Orthopedics filed a short-form complaint against Multiplan, Inc., Aetna, Inc., Cigna Group, Highmark Health, Horizon Healthcare Services, Humana Inc., and UnitedHealth Group Inc. in the Northern District of Illinois [citation:2]. The case alleges antitrust violations under 15 U.S.C. § 1 and has been assigned to Judge Franklin U. Valderrama [citation:2].
The Legal Framework: Why These Cases Matter
The DOJ’s lawsuits share common themes that signal a coordinated enforcement strategy:
- Market power does not require a monopoly. In the OhioHealth case, DOJ stakes out the position that a 35% market share is sufficient to infer market power vis-à-vis insurers [citation:9].
- “Must-have” status triggers scrutiny. The DOJ alleges that payors “must have” NYP and OhioHealth to sell viable insurance products in their respective markets [citation:3].
- All-or-nothing contracting is a target. Both complaints focus on requirements that insurers include all system facilities to have any access.
- Anti-steering provisions are unlawful. Restrictions on insurers’ ability to steer patients to lower-cost providers are squarely in the crosshairs.
- Price transparency limitations are challenged. OhioHealth’s alleged gag rules preventing insurers from sharing price information are characterized as anticompetitive.
According to Arnold & Porter analysis, “These enforcement actions make clear that the DOJ Antitrust Division is focused on certain payor contracting practices of large health systems, including ‘all or nothing’ and anti-steering provisions, even when those systems face meaningful local competition.”
What This Means for Employers
The wave of antitrust enforcement has significant implications for employers who sponsor self-funded health plans.
Potential for Lower-Cost Plan Designs
The DOJ’s complaints specifically identify the types of “budget-conscious plans” that hospital systems are allegedly blocking, including narrow networks, tiered plans, centers of excellence, site-of-service steering, and reference-based pricing. If the DOJ succeeds in these cases, employers may gain access to more innovative, cost-saving plan designs.
Learn more about conducting a benefits audit to identify opportunities for cost savings in your health plans.
Increased Transparency
The OhioHealth complaint specifically challenges “gag rules” that prevent insurers from sharing price information with patients. Successful litigation could lead to greater price transparency, allowing employers and employees to make more informed healthcare decisions.
Potential for Follow-On Private Litigation
According to Katten Muchin Rosenman analysis, “These actions by federal enforcers seek injunctive relief requiring the health system to restructure its contracts with payors. Such enforcement actions may also invite follow-on private litigation (or bolster ongoing litigation) seeking money damages.”
Looking Ahead: What to Expect
The rapid succession of these lawsuits—filed just weeks apart—suggests additional cases in other geographic markets may be in the pipeline [citation:5].
Acting Assistant Attorney General Assefi has stated that the “Antitrust Division will continue to hold hospitals violating the antitrust laws accountable” [citation:5]. The division’s focus on healthcare “pocketbook issues” aligns with the Trump administration’s broader emphasis on lowering costs for American families.
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Conclusion: A Turning Point for Healthcare Affordability
The wave of litigation against healthcare carriers, hospital systems, and pricing intermediaries represents a turning point in the fight for healthcare affordability. With the DOJ filing two major hospital antitrust cases in early 2026, the MultiPlan litigation advancing toward trial, and the Zelis case clearing judicial review, 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 sued New York-Presbyterian Hospital on March 26, 2026, alleging anticompetitive contract restrictions that inflate healthcare costs in New York City
- The DOJ and Ohio AG sued OhioHealth on February 20, 2026, challenging all-or-nothing contracting, anti-steering provisions, and price transparency restrictions
- MultiPlan (Claritev) and major insurers face federal antitrust litigation for allegedly facilitating a horizontal price-fixing conspiracy that suppressed out-of-network payments
- Zelis Healthcare and five major insurers face similar claims in Massachusetts federal court over repricing technology that allegedly forced providers to accept payments as low as 1% of billed charges
- Carolina Neurosurgery and Orthopedics filed an antitrust complaint against Multiplan and major insurers in the Northern District of Illinois on March 6, 2026
- Common targets include all-or-nothing contracting, most-favored-tier requirements, anti-steering provisions, and price transparency gag rules
- The DOJ has signaled that market shares as low as 25-35% may be sufficient to establish market power in hospital contracting cases
- Employers may gain access to more innovative, lower-cost plan designs (narrow networks, tiered plans, site-of-service steering) if the DOJ succeeds
- Follow-on private litigation seeking money damages is likely to follow successful DOJ enforcement actions
- Resources: DOJ Antitrust Health Care, CMS
This comprehensive guide was published on May 21, 2026. Sources include Freshfields, Arnold & Porter, Duane Morris, Katten Muchin Rosenman, Courthouse News Service, Medical Society of the State of New York, and Insurance Business America.
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