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BREADCRUMB

 1. Justice.gov
 2. Antitrust Division
 3. Help Us Ensure Access To Fair and Competitive Healthcare Markets For You and
    Your Family.




HELP US ENSURE ACCESS TO FAIR AND COMPETITIVE HEALTHCARE MARKETS FOR YOU AND
YOUR FAMILY.

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Everyone deserves access to a competitive healthcare marketplace.

If you need medical care, fair competition helps lower the price you pay and
improve the quality of your care. If your job is in healthcare, competition
helps you get a fair wage and opportunities to grow.

The Department of Justice’s Antitrust Division, the Federal Trade Commission,
and the Department of Health and Human Services work to promote competitive and
fair healthcare markets.

Information from the public is vital to our work.



If you would like to submit a healthcare competition complaint, please use the
button below.

This form is only to be used to submit complaints about healthcare competition.
Please do not submit complaints about failure to pay claims or cover healthcare
services, increases in individual insurers’ rates, billing disputes, or general
unhappiness about the healthcare system.

To report a tip or complaint about fraud, abuse, or misconduct related to
Medicare, Medicaid, or other programs of the U.S. Department of Health and Human
Services, please submit the tip or complaint to the HHS Office of Inspector
General’s hotlineLinks to other government and non-government sites will
typically appear with the “external link” icon to indicate that you are leaving
the Department of Justice website when you click the link. or call
1-800-HHS-TIPS (1-800-447-8477). In addition, a private citizen may initiate a
lawsuit under the False Claims Act (called “qui tam” suits) alleging that such
conduct resulted in fraud or false claims being submitted to the government,
including to government healthcare programs such as Medicare, Medicaid, and
TRICARE. Learn more about the False Claims Act.

To report other instances of fraud, scams, and bad business practices, please
use the FTC’s Report Fraud portalLinks to other government and non-government
sites will typically appear with the “external link” icon to indicate that you
are leaving the Department of Justice website when you click the link..

To report allegations of information blocking, please go to Information Blocking
| Health IT Feedback and Inquiry PortalLinks to other government and
non-government sites will typically appear with the “external link” icon to
indicate that you are leaving the Department of Justice website when you click
the link. or the OIG HotlineLinks to other government and non-government sites
will typically appear with the “external link” icon to indicate that you are
leaving the Department of Justice website when you click the link., or call
1-800-HHS-TIPS (1-800-447-8477).

Submit a Complaint

FEDERAL LAWS ENSURE HEALTHY COMPETITION

 * The Sherman Act prohibits certain agreements between companies that harm
   competition. It also prohibits companies from unlawfully gaining or
   maintaining monopoly power.
 * The Clayton Act prohibits companies from merging when the merger may
   substantially lessen competition.
 * The Federal Trade Commission ActLinks to other government and non-government
   sites will typically appear with the “external link” icon to indicate that
   you are leaving the Department of Justice website when you click the link.
   prohibits unfair methods of competition. It also prohibits companies from
   acting in unfair or deceptive ways.
 * The Robinson-Patman ActLinks to other government and non-government sites
   will typically appear with the “external link” icon to indicate that you are
   leaving the Department of Justice website when you click the link. prohibits,
   among other things, a seller from charging competing buyers different prices
   for the same commodity or discriminating in the provision of allowances or
   services furnished or paid to customers.

EXAMPLES OF CONDUCT THAT CAN HARM COMPETITION IN HEALTHCARE

Consolidation, Joint Ventures, and “Roll-ups” of Healthcare Providers or
Companies

Description:

Competition works best when many companies in the market compete for your
business. Often, one owner buys many companies, consolidates them, or combines
them to eliminate competition and the benefits of competition to you.

Consolidation in the healthcare industry can occur in many ways:

 * Mergers – When large companies merge with each other, eliminating competition
   in the market. This loss of competition can occur across pharmaceutical
   companies, hospitals and other providers, insurers, and more.
 * “Roll-ups” (also called serial acquisitions) – When a firm buys multiple
   small but similar businesses in the same area. Such conduct reduces the
   number of competitors over time. 
 * Cross-market mergers – When firms that work in the same industry but in
   separate geographic areas merge. For example, a hospital system in one part
   of the state acquires a hospital in another part of the state. These mergers
   may harm competition if the merged firm uses its newly amassed
   influence—influence over, for example, a statewide employer or other
   insurer—to affect price, access, or quality.   
 * Partial acquisitions – When a firm gets less-than-full control of another
   competing firm. These acquisitions may harm competition by giving the partial
   owner an ability to influence strategic decisions of the competing firm. Such
   loss of competition could reduce the partial owner’s incentive to compete and
   give the partial owner access to non-public, competitively sensitive
   information.
 * Vertical mergers – When companies along varying levels of the supply chain
   merge. For example, a hospital system that buys a large physician practice
   that does a lot of patient referrals. These mergers may harm competition by:
   * lowering incentives to compete;
   * limiting a rival firm’s access to a product, service, or route to market;
   * giving or increasing access to a rival’s non-public, competitively
     sensitive information; or
   * deterring rivals or potential rivals from investing.
 * Joint venture – 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, quality, or innovation.

When healthcare firms consolidate or pursue a joint venture, they often say that
it will result in “efficiencies.” Healthcare firms may close or downsize their
facilities. Such conduct may result in higher prices, lower quality, less access
to care, and fewer job opportunities.

If mergers or joint ventures substantially lessen competition or tend to create
a monopoly, they violate antitrust law.

Examples:

 * A private equity company buys a series of nursing homes or medical practices
   in the same area. It also uses its influence to enter into agreements with
   other providers that fix prices.
 * A health insurance company buys several medical practices that compete with
   each other. It also prohibits its medical practices from contracting with
   rival health insurance companies.
 * A pharmacy benefit manager buys a series of small independent pharmacies or
   specialty pharmacies. It also uses its influence to reimburse its pharmacies
   at a higher rate than other pharmacies.
 * A hospital system buys other hospitals, outpatient facilities, or medical
   practices. It also alters its referral patterns to favor its practices over
   competing hospital systems. 
 * After a merger, a hospital system closes some of its facilities or reduces
   services. Such conduct results in higher prices, longer wait times, less
   access to care, lower quality, or job loss.
 * After an acquisition, providers change their coding practices to upcharge
   payers and produce overpayments without changes in care.
 * A hospital system acquires minority interests of a competing hospital system.
   They 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 to share competitively
   sensitive information or divide markets.

Limiting Choice and Fair Wages for Healthcare Employees

Description:

Competition helps healthcare employees get higher wages, better benefits, and
improved working conditions. Patients can also benefit. A more competitive
healthcare workforce may increase access to treatments and quality of care.
Sometimes employers make agreements with each other (written or verbal) that
limit competition. 

Agreements among competitors to limit or fix the terms of employment for
employees (current and potential) can violate the antitrust laws. For example,
wage-fixing, no-poach, and no-solicitation agreements between competitors are
unlawful. Other agreements, such as non-compete clauses, constrain a single
firm’s decision-making about wages, salaries, or benefits. These agreements may
be illegal in certain circumstances.

Examples:

 * A hospital prohibits an employee from working for another hospital or
   physician practice for a specific period of time or in a particular
   geographical area after employment ends.
 * A large employer in a geographic area follows a no-rehire policy for
   employees that leave the job.
 * A health system revokes a physician’s medical staff privileges for having
   ownership in a competing facility.
 * Different employers agree to set wages at the same level or give the same
   benefits.
 * Different employers agree not to poach or recruit each other’s employees.
 * An employer requires an employee to sign an agreement saying they will not
   compete with the employer after leaving the job.
 * Competing employers agree to divide employees among themselves.
 * Competing employers share terms and conditions of employment, including
   current and future wage information.

Collusion or Price Fixing Among Competitors

Description:

Healthcare companies should compete for your business. Competition often results
in lower prices, better quality, greater access, and increased innovation.
Sometimes companies make agreements with each other (written or verbal) instead
of competing.

That behavior can violate federal laws. Antitrust laws prohibit certain kinds of
agreements among competitors. This includes:

 * Price fixing – When competitors agree to raise, fix, or maintain the price of
   goods or services. 
 * Bid rigging – When competitors agree in advance on the price or terms of
   their competitive bids. The government or a business may identify and request
   goods or services from another company through the competitive bidding
   process to award business contracts.
 * Market allocation – When competitors agree to divide markets among
   themselves. Market allocation includes agreeing to sell only to specific
   customers or areas.

Examples:

 * Competing healthcare companies, such as providers or pharmaceutical
   companies, collectively set prices or negotiate reimbursement rates at
   certain prices or levels.
 * Competing healthcare companies divide customers among themselves.  
 * Competing healthcare companies agree to only bid in certain areas or on
   certain projects.
 * Competing healthcare companies agree to take turns to win bids.
 * Competing healthcare companies agree to allow the same companies to win or
   lose a bid.
 * Competing healthcare companies agree to stop providing anticipated discounts
   or rebates.
 * Competing healthcare companies agree to end up winning the same amount of
   work over a series of bids.
 * Competing healthcare companies agree to not market to customers in each
   other’s geographies.

Preventing Transparency

Description:

Patients need to know about their healthcare options and costs to make informed
choices. Transparency promotes competition by helping consumers to make better
choices. Actions to limit transparency can violate several federal laws, such as
the antitrust laws.

Examples:

 * A hospital system or insurer inserts language into their contracts that keeps
   patients from knowing the negotiated rates or other costs of services.
 * 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
   interferes with access, exchange, or use of patient’s electronic health
   information that is permitted under the Health Insurance Portability and
   Accountability Act of 1996 (HIPAA) and consistent with how the patient wants
   to access their electronic health information.

Healthcare Contract Language and Other Practices That Restrict Competition

Description:

Healthcare companies sometimes add language into their contracts with other
companies or with patients that limits competition or enter into settlements
that have the same effect. These clauses, contracting practices, and settlement
agreements come in many forms.

Examples:

 * Anti-tiering and anti-steering clauses (also known as anti-innovation,
   anti-incentive, or anti-discounting clauses): These clauses keep a health
   insurer from giving incentives, such as discounts, to guide patients to use
   cheaper or higher quality healthcare providers. These clauses impede
   competition by lessening incentives to lower cost, provide quality care, and
   innovate.
   
   This can occur when:
   
   * A hospital system requires an insurer to put all its physicians, hospitals,
     and healthcare facilities in the most favorable tier of providers.
   * A hospital system requires an insurer to put all its physicians, hospitals,
     and healthcare facilities at the lowest cost-sharing rate, so patients do
     not go to other providers.

 * Exclusive contracting: Exclusive contracting prevents buyers from contracting
   with any other seller. This may harm competition and result in higher prices.
   
   This can occur when:
   
   * A dominant healthcare provider prevents an insurer from contracting with
     other competing providers.
   * A dominant health insurer prevents a healthcare provider from contracting
     with other competing insurers.

 * All-or-nothing clauses: These clauses require a health insurer to contract
   with all the providers’ facilities or none at all. Health insurers often need
   to include a “must-have” provider in their network to sell a viable health
   plan. By inserting an all-or-nothing clause, health systems can use their
   “must-have” provider to make sure their other facilities are included in the
   network. They can also demand higher rates for all facilities in the entire
   health system. These clauses can harm competition because they result in
   higher prices and less innovation.
   
   This can occur when:
   
   * An insurer wants to contract with a single hospital. However, the hospital
     system requires the insurer to contract with all its facilities at high
     rates.

 * Commercial price parity clauses: These types of clauses may harm competition
   by facilitating illegal agreements on price among commercial competitors or
   unlawful acquisition or maintenance of a monopoly. This can result in higher
   prices and reduce competition that would benefit consumers.
   
   This can occur when:
   
   * 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 negotiated
     reimbursement rates are the best rates available.
   * An insurer requires a provider to share negotiated reimbursement rates paid
     by other insurers.

 * Generic drug delay tactics: Brand drug manufacturers use various tactics to
   delay or block generic drug manufacturers from launching their lower-priced
   generic drug alternatives.
   
   This can occur when:
   
   * Brand drug manufacturers agree to settle patent lawsuits with generic drug
     manufacturers by paying the generic manufacturer to delay the launch of
     generic drugs.
   * Brand drug manufacturers make new, minor modifications to a brand drug with
     an expiring patent while decreasing or eliminating production of the
     original version of the brand drug.
   * Brand drug manufacturers improperly list their patents in the Orange Book.
   * Brand drug manufacturers prevent generic drug manufacturers from obtaining
     drug samples for necessary testing.
   * Brand drug manufacturers sell or threaten to sell an authorized generic
     drug to delay the launch of generic drugs.

Anticompetitive Uses of Healthcare Data

Description:

Healthcare companies accumulate data at a rapid pace. Acquisition and control of
large amounts of data by a few companies can threaten healthy competition. It
may allow those companies to prevent other companies from entering the market
and reduce future innovation. It may also allow them to determine who gets care
at what price. These companies also may be able to surveil their rivals or use
data to harm competition. Certain conduct may violate the antitrust laws even if
such conduct is consistent with HIPAA.

Examples:

 * An insurer acquires a company to access and obtain data rights to claims data
   of other competing insurers.
 * A hospital or insurer shares detailed utilization or claims data among
   competitors.
 * A healthcare provider or electronic health information/records vendor
   interferes with access, exchange, or use of a patient’s electronic health
   information that is consistent with how the patient wants to access their
   electronic health information.

Unnecessary Healthcare Provider Recertification or Accreditation Requirements

Description:

Certifying bodies or accreditation organizations can impose unnecessary
requirements on healthcare providers. Unnecessary requirements can raise the
costs of practicing medicine. They can also reduce the number of healthcare
practitioners participating in the marketplace. These requirements can harm
competition and increase the cost of healthcare services.

Example:

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

WE WANT TO HEAR FROM YOU

Are any of these practices harming competition in your healthcare?

Information from you could be our first alert to a possible violation of
antitrust laws. Your complaint could give the evidence needed to begin an
investigation.

Information from the public is vital to our efforts to promote healthy
competition.

This form is only to be used to submit complaints about healthcare competition.
Please do not submit complaints about failure to pay claims or cover healthcare
services, increases in individual insurers’ rates, billing disputes, or general
unhappiness about the healthcare system.

To report a tip or complaint about fraud, abuse, or misconduct related to
Medicare, Medicaid, or other programs of the U.S. Department of Health and Human
Services, please submit the tip or complaint to the HHS Office of Inspector
General’s hotlineLinks to other government and non-government sites will
typically appear with the “external link” icon to indicate that you are leaving
the Department of Justice website when you click the link. or call
1-800-HHS-TIPS (1-800-447-8477). In addition, a private citizen may initiate a
lawsuit under the False Claims Act (called “qui tam” suits) alleging that such
conduct resulted in fraud or false claims being submitted to the government,
including to government healthcare programs such as Medicare, Medicaid, and
TRICARE. Learn more about the False Claims Act.

To report other instances of fraud, scams, and bad business practices, please
use the FTC’s Report Fraud portalLinks to other government and non-government
sites will typically appear with the “external link” icon to indicate that you
are leaving the Department of Justice website when you click the link..

Submit a Complaint





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