Healthcare Competition Complaint

• A private equity company buys a series of nursing homes or medical practices in the same area. That same company also uses its influence to enter into agreements with other nursing homes or medical practices that it does not own to fix prices.
• A health insurance company buys several competing medical practices. It also prohibits its medical practices from contracting with rival health insurance companies.
• A pharmacy benefit manager buys a series of small independent or specialty pharmacies. It also uses its influence to reimburse its pharmacies more than other pharmacies.
• A hospital system buys other hospitals, outpatient facilities, or medical practices. It also changes how it refers patients to benefit itself more than competing systems.
• After a merger, a hospital system closes some of its facilities or reduces services. This results in higher prices, longer wait times, less access to care, lower quality, or fewer employment opportunities.
• After an acquisition, providers change their coding practices to charge more without making changes in care.
• A hospital system buys part of a competing hospital system but does not control its competitor. As a result of the partial acquisition, the buyer can:
  • appoint board members,
  • watch board meetings,
  • impact operational decisions,
  • veto the competing hospital’s ability to raise capital, or
  • access competitively sensitive information.
• Competing hospital systems start a joint venture. With the joint venture, they share competitively sensitive information or divide markets.

• A dominant employer in a geographic area follows a no-rehire policy for employees that leave the job.
• Competing employers agree to:
  • set wages at the same level or give the same benefits
  • not hire or recruit each other’s employees
  • divide employees among themselves
  • share current and future terms and conditions of employment.
• An employer requires an employee to sign an agreement saying they will not
  • compete with the employer after leaving the job
  • work for a competing employer for a specific amount of time or in a specific area
• A health system revokes a physician’s medical staff privileges for having ownership in a competing facility

• Agree to set prices or negotiate reimbursement rates at certain prices or levels.
• Divide customers among themselves.   
• Agree to only bid in certain areas or on certain projects.
• Agree to take turns to win bids.
• Agree to allow the same companies to win or lose a bid.
• Agree to stop providing anticipated discounts or rebates.
• Agree to end up winning the same amount of work over a series of bids.
• Agree to not market to customers in each other’s geographies.

• A hospital system or insurer uses their contracts to keep patients from knowing the costs of the services they receive.
• A hospital or insurer does not provide the prices of services in a public and easy-to-read format.
• A healthcare provider or electronic health information/records vendor prevents patients from accessing their electronic health information in ways allowed under HIPAA and consistent with how the patient wants to access their electronic health information.

• Anti-tiering/anti-steering clause
  • A hospital system makes an insurer put all the system’s physicians, hospitals, and facilities:
    • in the most favorable tier, or
    • at the lowest cost-sharing rate.
• Exclusive contracting clause
  • A dominant healthcare provider prevents an insurer from contracting with other competing providers.
  • A dominant health insurer prevents a provider from contracting with other competing insurers.
• All-or-nothing clause
  • When insurer wants to contract with a single hospital, but the hospital system makes them contract with all its facilities at high rates.
• Commercial price parity clause
  • A hospital system guarantees that an insurer will receive better or equal terms as those provided to any other insurer.
  • An insurer requires a provider to
    • certify that the agreed-upon reimbursement rates are the best rates available, or
    • share negotiated reimbursement rates paid by other insurers.
• Generic drug delay tactics
  • Brand drug manufacturers
    • agree to settle patent lawsuits with generic drug manufacturers by paying the generic manufacturer to delay the launch of generic drugs;
    • make new, minor modifications to a brand drug with an expiring patent and decreasing or eliminating production of the original version of the brand drug;
    • improperly list their patents in the Orange Book;
    • prevent generic drug manufacturers from obtaining drug samples for necessary testing; or
    • sell or threaten to sell an authorized generic drug to delay the launch of generic drugs

• An insurer acquires a company to gain access and rights to claims data of other competing insurers.
• A hospital or insurer shares detailed use or claims data among competitors.
• An electronic health records vendor prevents competitors from accessing patients’ electronic health information that is consistent with patient preferences and HIPAA.

• Certifying bodies or accreditation organizations ask physicians to meet unnecessary requirements to stay certified.

The examples above reflect some but not all types of anticompetitive or unfair healthcare practices. Select this option if you don’t see an example that applies to your situation. You will be able to tell us more later.