Submit a complaint about healthcare competition

• Mergers – When companies that provide the same goods or services combine. Mergers can eliminate competition in the healthcare markets. All types of companies in the healthcare markets can merge, including:
  • pharmaceutical companies;
  • hospitals, physicians, and other providers of healthcare or services;
  • insurers; and
  • more.
• Vertical mergers – When companies along different levels of the supply chain, such as a health insurer and a medical practice, or a hospital and a medical devices supplier, combine. Vertical mergers may harm competition by:
  • increasing the combined company’s ability to raise prices or lower quality of care;
  • lowering incentives to compete;
  • limiting or blocking a competitor’s access to a product, service, or route to market;
  • providing access to a competitor’s non-public, competitively sensitive information; or
  • deterring rivals or potential rivals from investing in the market.
• Joint ventures – When competing companies combine or share resources to achieve a common goal. A joint venture may harm competition if it involves agreements to influence:
  • prices,
  • access to services or goods,
  • quality, or
  • innovation.
• “Roll-ups” (also called serial acquisitions) – When a single company buys multiple small businesses that compete. Roll ups may harm competition if the company that purchased the smaller businesses increases prices or reduces the quality of healthcare provided to patients.
• Cross-market mergers – When companies that provide the same goods or services, but do not directly compete because of the distance between their physical locations, combine. The new company may harm competition if it uses any increased power to negatively affect price, access to healthcare, or quality.
• Partial acquisitions – When a company buys less-than-full control of a competing company. Partial owners of competing companies may harm competition if they:
  • can influence the strategic decisions of the competing company,
  • have decreased incentives to compete, or
  • gain access to non-public, competitively sensitive information.

Spoken or written agreements among competing healthcare companies to limit or pre-determine the terms of employment for employees (current and potential). Some of these types of agreements include:

• Wage-fixing – When competing employers agree to set wages at the same level or give the same benefits.
• No-poach – When competing employers agree to not hire each other’s employees.
• No-solicitation – When competing employers agree to not recruit each other’s employees.

In certain circumstances, non-compete clauses in employment agreements may unlawfully constrain a company’s decisions about wages or salaries, job mobility, or benefits. 

Written or spoken agreements not to compete. Some of these types of agreements include:

• Price fixing – When competitors agree to raise, set, or maintain the price of goods or services.
• Bid rigging – When competitors agree in advance on prices or terms of their competitive bids.
• Market allocation – When competitors agree to divide markets among themselves. Market allocation includes agreeing to sell only to specific customers or areas.

When healthcare companies prevent patients from knowing the prices charged for their healthcare services or available healthcare options. Some of these practices include when healthcare companies:

• draft contracts to keep patients from knowing prices.
• fail to provide prices in a public, accessible, and easy-to-read format.
• refuse to give patients access to their electronic health information:
  • as allowed under the Health Insurance Portability and Accountability Act of 1996 (HIPAA); and
  • consistent with how the patient wants to access their electronic health information.

• Agreements with anti-tiering and anti-steering clauses (also known as anti-innovation, anti-incentive, or anti-discounting clauses) – Clauses in agreements that stop health insurers from giving incentives (such as discounts) or guiding patients to lower cost or higher quality healthcare providers.
• Exclusive contracting – Agreements that prevent buyers from contracting with other sellers.
• Agreements with all-or-nothing clauses – Clauses in agreements that require a health insurer to contract with all the providers in a health system, or none of the providers in the health system. These types of clauses can result in higher prices and less innovation.
• Agreements with commercial price parity clauses – Clauses in agreements that prohibit healthcare suppliers or buyers from offering lower prices or better terms to other buyers or suppliers, respectively. These clauses may facilitate illegal price agreements between competitors. They can also result in higher prices and reduced competition by requiring providers to:
  • guarantee that an insurer will receive contract terms that are better than, or equal to, the contract terms provided to other insurers;
  • certify that their reimbursement rates are the best rates available; or
  • share the reimbursement rates they’ve negotiated with other insurers.
• Practices or tactics that delay introduction of generic drugs: Tactics by brand-name drug manufacturers to delay or block generic competitors from launching lower-priced generic drug alternatives. 

When just a few companies acquire and control large amounts of health-related data, the company may be able to:

• prevent other companies from entering the market; or
• reduce the incentives a competitor may have to innovate.

Despite complying with HIPAA, data transfers may harm competition when competing companies:

• gain access and rights to claims data maintained by their competitors;
• share detailed use or claims data;
• share data in a way that may allow companies to monitor their rivals; or
• use data in other ways that may harm competition.

When certifying bodies or accreditation organizations impose unnecessary recertification or accreditation requirements on healthcare providers. These requirements may:

• raise the cost of your healthcare service or
• decrease the number of healthcare practitioners available to you.