Health systems are facing growing pressure to rein in their prices, requiring some major systems to defend their pricing policies in court.
Several health systems have been accused in recent lawsuits of abusing their market power, causing insurers and patients to unjustly pay more for services.
The push for health systems to curb price increases is coming from the courts, state and federal lawmakers, employers, insurers and healthcare researchers. The conversations will likely ramp up as health systems continue to navigate high labor and supply costs, rising interest rates and other financial headwinds.
Here are three pending antitrust lawsuits.
Uriel Pharmacy v. Advocate Health
Uriel Pharmacy, a self-insured pharmacy, sued Advocate Health in May 2022 for allegedly using all-or-nothing contract provisions to force Wisconsin employers and commercial insurers to pay excessive prices rather than steer patients to lower-cost competitors.
The suit alleges Advocate charges more than competitors for routine services like a colonoscopy with a biopsy, which costs $10,700 at Advocate's St. Luke's Medical Center in Milwaukee compared with $4,700 at Froedtert Hospital in Milwaukee. In addition, Advocate allegedly implemented a policy on Oct. 1, 2020 that it refused to accept payment from or submit claims to self-funded health plans that use reference-based pricing, where payments are based on a percentage above the hospital's Medicare rates.
An Advocate spokesperson said in a statement that the lawsuit "consists of a series of groundless attacks, meager allegations and mischaracterization of ordinary business practices."
Charlotte, North Carolina-based Advocate sought to have the case dismissed, arguing that Uriel improperly defined the geographic service areas and that the lawsuit didn't include language from Advocate's contracts with insurers, among other claims. The motion to dismiss was denied in April by U.S. District Court for the Eastern District of Wisconsin Judge Lynn Adelman. Adelman ruled the geographic markets were properly defined and that Uriel shouldn't be expected to have access to the Advocate-insurer contracts and the argument it presented sufficed.
A pre-trial conference report submitted in August outlined a tentative schedule of court proceedings, including the close of discovery by Feb. 19, 2025. A trial date has not been set.
City of Brevard, North Carolina v. HCA Healthcare
The city of Brevard, North Carolina, sued HCA Healthcare in June 2022 for allegedly forcing insurers and employers into anticompetitive contracts.
The city alleges the contracts required insurers and employers to include all HCA facilities in the Asheville, North Carolina region in their health plan networks and barred payers from steering patients to competitors. HCA uses anti-steering clauses, gag orders that impede price transparency and prevents employers from implementing tiered or narrow networks, the suit alleges. While the anticompetitive conduct took place before HCA's $1.5 billion Mission Health acquisition, it increased after the deal closed in 2019, the lawsuit alleges.
An HCA spokesperson denied the allegations.
Nashville, Tennessee-based HCA filed a motion to dismiss the case in September 2022, which awaits a ruling from U.S. District Court for the Western District of North Carolina Judge Martin Reidinger. In its motion to dismiss, HCA claims the city failed to demonstrate that the health system "unlawfully obtained or maintained monopoly power over acute-care or outpatient services in any market," and that HCA's market share was legally justified through the certificate of public advantage that permitted the Mission acquisition.
John Brown, et al v. Hartford HealthCare
John Brown, along with five other Connecticut residents, filed a lawsuit in February 2022 against Hartford (Connecticut) HealthCare, alleging it used its dominant market share to hike prices and limit competition, in part by forcing insurers to include all or none of the system’s hospitals in their health plan networks, regardless of price or quality. The complaint alleges Hartford's prices are routinely more than 20% higher than its nearest competitor, and prices for high-volume procedures like colonoscopies and blood transfusions are often hundreds of dollars more than nearby hospitals.
A Hartford spokesperson said in a statement that it "continues to maintain that this lawsuit has no merit."
In December, Hartford filed a motion to dismiss the lawsuit, arguing that the plaintiffs do not have standing to make federal antitrust law violation allegations, among other claims. The motion awaits a ruling from Hartford District Superior Court Judge John Farley.