The Department of Justice has reached a proposed settlement with OhioHealth Corporation over allegations that the health system used its market power to limit insurers' ability to offer lower-cost, consumer-focused health plans. The agreement resolves a federal and state antitrust lawsuit alleging OhioHealth's contracts restricted insurers from steering members toward providers based on cost, quality or other factors.
The Justice Department's Antitrust Division and the Ohio Attorney General's Office sued OhioHealth in February, alleging that the health system's contracting practices limited competition in the Columbus health care market. The agencies alleged the provisions violated federal and state antitrust laws, including Section 1 of the Sherman Act and Ohio's Valentine Act.
OhioHealth, a Columbus-based nonprofit health system, operates 16 hospitals and more than 200 outpatient facilities across roughly 50 counties. Regulators described the system as the dominant hospital provider in central Ohio, competing primarily with Ohio State University Wexner Medical Center and Mount Carmel Health System.
According to the complaint, OhioHealth required insurers that included the health system in their networks to include OhioHealth facilities across all commercial insurance products. Regulators alleged those "all-or-nothing" provisions made it more difficult for insurers to offer plan designs that relied on narrower provider networks or other cost-management strategies.
Regulators also alleged the contract terms limited insurers' ability to share information with patients about health care costs and alternative providers, as well as their ability to encourage patients to seek lower-cost care options.
The proposed settlement would prevent OhioHealth from entering into or enforcing contract provisions that prohibit, deter or penalize insurers for offering steering programs, transparency efforts or benefit designs that encourage members to use certain providers.
The agreement addresses tools such as narrow networks, tiered networks, site-of-service incentives, reference-based pricing and centers of excellence programs.
The settlement would void existing contract provisions that regulators say restrict these types of plan features and would prohibit OhioHealth from seeking similar provisions in future contracts. OhioHealth would also be required to notify relevant insurers and submit compliance reports under a five-year monitoring period.
OhioHealth will not pay penalties or damages under the agreement and said it does not admit wrongdoing. The health system said the contract provisions at issue were created years ago to address industry practices that have since changed. The Ohio Attorney General's Office said the settlement would promote greater patient choice by allowing insurers to provide more information about cost and provider options.
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