The Department of Justice Antitrust Division has placed large hospital systems squarely in its enforcement sights, filing back-to-back Sherman Act Section 1 lawsuits that target…
The Department of Justice Antitrust Division has placed large hospital systems squarely in its enforcement sights, filing back-to-back Sherman Act Section 1 lawsuits that target the contractual terms hospitals use to negotiate with commercial health insurers. In February 2026, the Division sued OhioHealth, and on March 26, 2026, it followed with a parallel action against NewYork-Presbyterian. Together, these cases mark one of the most consequential federal antitrust pushes into healthcare market power in recent memory, and they should prompt every dominant health system and payor in the country to reexamine its contracting playbook.
At the center of both complaints are so-called 'all-or-nothing' provisions and anti-steering clauses. According to the DOJ, all-or-nothing terms require insurers to include every hospital and facility in a health system's portfolio if they want access to any one of them, while anti-steering clauses restrict insurers from designing plans that direct patients toward lower-cost, higher-value providers. The Division alleges that, in combination, these provisions prevent insurers from offering narrow-network or tiered plan designs that could deliver meaningful savings to employers, employees, and individual consumers.
The paired filings are significant for what they signal as much as for what they allege. By bringing two Section 1 cases in rapid succession against prominent regional systems on opposite sides of the country, the Antitrust Division has confirmed that hospital payor contracting is a sustained federal priority rather than an isolated enforcement experiment. Health systems with substantial regional market share should anticipate that contract language long viewed as routine may now draw scrutiny.
Practical next steps include auditing existing payor agreements for all-or-nothing, anti-tiering, anti-steering, gag, and most-favored-nation provisions; reviewing internal communications and negotiation practices that touch on network design; and evaluating whether current contracting positions can be supported by legitimate procompetitive justifications. Insurers, for their part, should reassess whether contract terms they have previously accepted are still defensible and consistent with their network strategy.
This article is provided for general informational purposes and does not constitute legal advice. Clients facing specific contracting or enforcement questions should seek tailored counsel based on their individual circumstances.