Feds, state sue OhioHealth for allegedly blocking lower-cost health plans

 The Justice Department and the state of Ohio on Feb. 20 filed a civil antitrust lawsuit against OhioHealth, alleging the system used anticompetitive contract provisions to drive up healthcare costs for patients and employers in central Ohio.

Four things to know: 

1. The complaint accuses OhioHealth of imposing contractual restrictions on commercial payers that prevented them from offering lower-cost, “budget-conscious” health plans. 

2. OhioHealth, a 16-hospital system, is the dominant health system in the Columbus area and allegedly has used its market power to require insurers to include its facilities in all of their commercial insurance networks, according to prosecutors. The lawsuit also alleges OhioHealth’s contracts effectively block payers from offering plans that steer patients to lower-cost competitors or provide price transparency tools.

3. OhioHealth competes in the Columbus market primarily with Ohio State University Wexner Medical Center and Mount Carmel Health System, which is owned by Livonia, Mich.-based Trinity Health. The Justice Department alleges OhioHealth’s reimbursement rates are higher than those of its competitors, while publicly available quality metrics do not show consistently higher performance.

4. The Justice Department and Ohio Attorney General Dave Yost aim to block OhioHealth from enforcing contract provisions that restrict insurers from offering plans that provide financial incentives or information encouraging members to use competing providers. The complaint also asks the court to prohibit OhioHealth from retaliating against insurers that attempt to introduce such plans.

“OhioHealth has been cooperating with the Department of Justice throughout its review of our managed care agreements,” a spokesperson for the health system said in a statement provided to Becker’s. “We are confident in our position and remain committed to full compliance with all applicable laws and regulatory requirements. As this is active litigation, we will not comment on specifics beyond what has been publicly disclosed.”

https://www.beckershospitalreview.com/legal-regulatory-issues/feds-sue-ohiohealth-for-allegedly-blocking-lower-cost-health-plans-4-things-to-know/