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In an irregular use of their enforcement powers, the Antitrust Division of the U.S. Department of Justice and the State of Ohio sued a large, central Ohio hospital system, OhioHealth, on Friday, February 20, 2026. The allegations claim that OhioHealth uses its market power and contracting practices to obtain higher reimbursement rates from managed care plans. This update summarizes and analyzes the complaint and claims leveled by the government.
OhioHealth owns and operates 16 hospitals, eight within the greater Columbus area and eight elsewhere in Ohio. Existing competitors in the central Ohio area include Ohio State University Wexner Medical Center and Mount Carmel Health System.
The DOJ complaint is premised upon contract language between OhioHealth and managed care plans, citing provisions such as:
- Requiring that the plans include all OhioHealth facilities in all networks for all products offered by that plan
- Requiring that the plans include all OhioHealth facilities at the most favored level of benefits in each network
- Limiting the plan’s ability to disclose OhioHealth’s prices
Though actual contract language is not included in the complaint, the allegations describe contract terms with specificity indicative of access to actual contracts between OhioHealth and plans. Presumably, some level of cooperation with the DOJ occurred with either OhioHealth or the plans or both. As characterized in the complaint, the contract provisions are not unusual, and plan contracts often obligate providers to agree to similar requirements that allow all plan affiliates and payers to access provider facilities at the rates and terms set forth in the contract.
The DOJ’s complaint focuses on inpatient hospital services in the greater Columbus area as the basis for its market share claims. Inpatient hospital services are defined as all services provided during a patient’s overnight hospital stay, excluding psychiatric care, rehabilitation services, pediatric services, or outpatient services. The DOJ alleges that OhioHealth controls “more than 35%” of inpatient hospital services in the greater Columbus area.
While the DOJ claims it is seeking to protect “patients and employers,” managed care plans are as much within the scope of the DOJ’s concerns. In fact, complaint allegations cite to negotiating experiences of plans, such as “Payors … have tried to negotiate the removal of these restrictions from their contracts with OhioHealth, but OhioHealth has summarily refused.” Further, the relief requested by the DOJ specifically applies to contracting practices with the managed care plans – for example, enjoining OhioHealth from agreeing to any contract provisions that limit a plan’s ability to “give members information and financial incentives to use any healthcare provider.”
The irony here is impossible to ignore – the DOJ is alleging monopolistic behavior and use of market dominance by a hospital system to the detriment of managed care plans, while many hospitals and other providers complain of the same circumstances by many managed care plans. Health plan contracts are notoriously one-sided in favor of the health plan. Community hospitals and non-hospital providers, such as physicians, have little or no leverage in negotiating equitable terms to the contract. When negotiating rates of payment, providers will often model reimbursement to cover the costs of care based upon the provider’s participation in all networks and products. If the health plan is permitted to cherry pick hospital’s participation in certain plans and products, the pricing model may not work to cover costs, and the contract will become a liability for the hospital. Contract provisions that protect the hospital’s ability to recover its costs of care do not appear to have reduced the health plans’ bottom line. Multiple stories in the past year in the Wall Street Journal and the New York Times, among other reporting outlets, cite to the tens of billions of dollars of profits generated annually by health plans with significant consolidation of health plan options occurring recently.
The case was filed in federal court in Columbus, Ohio. The State of Ohio chose to join the DOJ as a second plaintiff in the action, announcing in its press release that it was “standing with federal partners to protect consumers and restore competition in Ohio’s health-care market place.” OhioHealth must now answer the complaint within 21 days of when it receives actual service of the complaint. We will monitor this case closely, as will many others in both the health care and insurance industries.
