OhioHealth Care Settlement

The Department of Justice (DOJ) and the attorney general of Ohio have reached a settlement with OhioHealth Corporation, barring the healthcare system from seeking insurance contract provisions that deter or penalize steering. The settlement comes after a lawsuit filed in February, accusing OhioHealth of using its market power to maintain high prices and limit patient choices. This lawsuit marks an escalation in the DOJ’s efforts to tackle anti-competitive practices in the healthcare industry, targeting a health care system in Columbus that holds contracts with commercial health insurers accounting for at least 85 percent of the commercial health insurance business in the Columbus area.

OhioHealth’s Contracting Practices

The DOJ contends that OhioHealth’s contracts with insurers, which cover a significant majority of the local market, include provisions that hinder competition and limit patient choices. These restrictive clauses, often referred to as “anti-steering” and “gag rules,” prevent insurers from offering plans featuring lower-cost hospitals or informing patients about cheaper options. Some of these clauses include:

Prohibitions on narrow network plans, which could include a relatively limited set of cost-effective providers, encouraging insurers to offer more full plans instead.
Restrictions on tiered network plans, where members could secure healthcare from a lower-priced favored tier of providers or pay more for care from a more expensive tier.
Bans on centers of excellence, site of service steering, and reference-based pricing, which could help insurers identify and promote high-quality, cost-effective care.
Prohibitions on active transparency, preventing insurers from sharing pricing information to help patients make informed decisions about their healthcare.

The DOJ further alleges that OhioHealth’s contracts require insurers to include all of its providers in their networks, further insulating the system from price competition and helping to maintain its high prices. This all-or-nothing approach can deter insurers from offering more affordable, targeted network options that could steer patients towards lower-cost providers.

Settlement Details

The settlement, filed as Exhibit B: Proposed Final Judgment, addresses the key concerns raised by the DOJ and the attorney general of Ohio. It voids and prohibits OhioHealth from seeking or enforcing the restrictive contract provisions mentioned earlier. The settlement also bars the system from penalizing insurers for steering patients or providing rate transparency, promoting a more competitive and patient-centric market.