Justice Department Sues OhioHealth for Restrictive All-or-Nothing Insurance Contracting Provisions

Amidst continued focus on healthcare competition and costs by the federal antitrust agencies and state attorneys general, the U.S. Department of Justice (DOJ), along with the Attorney General of Ohio, filed a civil antitrust lawsuit on February 20, 2026, alleging OhioHealth Corporation’s (OhioHealth) insurance contract restrictions violate the federal Sherman Act[1] and Ohio’s Valentine Act, which prohibit anticompetitive conduct that harms consumers.  The complaint, filed in the U.S. District Court for the Southern District of Ohio, seeks to enjoin OhioHealth from enforcing its restrictive contractual terms.

According to the complaint, OhioHealth is the largest healthcare system in central Ohio, owning or managing 16 hospitals and outpatient facilities throughout the state.[2]  It allegedly uses its market power evidenced by its high market share in the sale of inpatient general acute care hospital services to force insurers to include OhioHealth in all their commercial insurance networks.[3]  Specifically, OhioHealth requires a payor that wants any of its providers in the payor’s network to include all of them in its network and requires that OhioHealth be featured at the most favored level of benefits in each network, regardless of how its prices compare to its competitors.[4] In this way, plaintiffs assert that OhioHealth generally forces insurers to include OhioHealth in all of the networks for the commercial insurance products they offer, regardless of how OhioHealth’s prices and quality of services compare to its competitors.[5] 

This practice allegedly deters entry and expansion of money-saving health insurance plans, resulting in reduced choice of insurance plans, higher healthcare costs, and less competition for high quality healthcare for patients, employers, and payors.[6] Plaintiffs cite examples of less costly plans, such as narrow network plans that include a limited set of cost-effective providers, tiered network plans that reward members with lower expenses if they choose cost-effective providers within the network, and centers of excellence that give patients an incentive to seek providers that offer better value within a broad network.[7]  These types of plan designs create price and quality competition among providers.[8]  However, the plaintiffs allege that OhioHealth impedes this type of competition by restricting payors from offering budget-conscious plan designs that could result in patients choosing its competitors for provision of care.[9]

To resolve these concerns, the plaintiffs seek to enjoin OhioHealth from entering or enforcing any provision that restricts a payor from offering plans that give members information and financial incentives to use any healthcare provider.[10]  By halting OhioHealth’s restrictions, the government believes insurers will be able to include more affordable, innovative plan options in their contracts with OhioHealth and in the commercial insurance products they sell to employers and families.[11] 

United States Attorney General Pamela Bondi further explained the motivation for the lawsuit, asserting that “Americans deserve low-cost, high quality healthcare – not anticompetitive hospital system contracts that make healthcare less affordable.”[12]  Indeed, “[t]he mission of the department under the leadership of Attorney General Bondi and of this administration is to be laser-focused on affordability,” said Omeed Assefi, Acting Assistant Attorney General for the DOJ’s Antitrust Division, in an interview on Friday.[13]  This enforcement agenda is not new, however, as evidenced by previous healthcare contracting cases, including DOJ’s 2018 action against Atrium Health and the State of California’s 2019 case against Sutter Health.

This case should be closely watched by healthcare participants, especially by those individuals involved in contracting. Attorney General Bondi vows that “this Department of Justice will continue taking legal action to protect consumers and drive down healthcare costs across America.”[14]  Assefi added, “[w]hat we want to do here is be as aggressive in enforcement as possible because of the returns that come to everyday people.”[15]  Likewise, Ohio Attorney General Dave Yost warned, “[m]y office stands with the Justice Department in our determination to eliminate these types of unfair practices and protect Ohioan’s wallets.”[16]

One final thing to note: DOJ, probably relying on some, but not universally all, cases stakes out the position that OhioHealth’s alleged 35 percent market share was sufficient to infer market power vis-à-vis insurers.

We will continue to monitor the OhioHealth case and similar enforcement actions and statements.  If you have any questions about potential antitrust risk arising from contracting practices in healthcare or otherwise, please contact one of the Mintz attorneys listed above or your regular Mintz attorney.
 

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