The
Department
of
Justice
filed
an
antitrust
lawsuit
against
NewYork-Presbyterian
Hospital
this
week,
alleging
the
provider
used
restrictive
payer
contracts
to
block
lower-cost
plans.
The
agency
claims
the
health
system
required
payers
to
include
all
of
its
hospitals
in
their
networks
if
they
wanted
access
to
any
of
them.
According
to
the
complaint,
those
provisions
limited
insurers’
ability
to
offer
more
affordable
plans
and
slashed
competition
from
lower-priced
providers.
Essentially,
the
Justice
Department
is
arguing
that
NewYork-Presbyterian’s
allegedly
anticompetitive
conduct
insulates
it
from
price
competition
and
allows
it
to
maintain
high
prices.
“Without
its
unlawful
contracts,
NYP
would
need
to
compete
more
vigorously
against
other
providers,
and
its
rivals
could
compete
to
attract
additional
patients
by
lowering
their
own
prices
or
investing
in
quality
improvements.
All
employers
and
patients
who
purchase
healthcare
in
New
York
City
would
benefit
from
lower
prices
and
higher
quality
as
the
healthcare
marketplace
becomes
more
competitive,”
the
complaint
read.
The
Justice
Department
contends
that
NewYork-Presbyterian’s
contract
provisions
violate
The
Sherman
Act
by
suppressing
competition
among
hospitals
and
physician
groups
in
New
York
City.
NewYork-Presbyterian
is
the
largest
health
system
in
New
York
City,
operating
eight
hospitals
and
dozens
of
outpatient
care
sites.
In
2024,
the
health
system’s
share
of
general
acute
care
discharges
was
more
than
25%
across
Manhattan,
Brooklyn,
Queens
and
the
Bronx,
the
complaint
stated.
This
is
far
more
than
its
competitors,
which
include
Mount
Sinai,
NYU
Langone
Health,
Northwell
Health
and
NYC
Health
+
Hospitals.
In
a
statement
sent
to
MedCity
News,
NewYork-Presbyterian
said
the
lawsuit
is
meritless.
The
health
system
also
stated
that
it
has
cooperated
with
the
Justice
Department,
complies
with
all
federal
and
state
laws,
and
believes
its
contracting
policies
are
pro-competitive.
“We
do
not
seek
to
exclude
any
other
hospital
from
any
insurer’s
network.
Nor
do
we
require
more
favorable
treatment
than
any
other
hospital.
In
our
contract
negotiations
with
insurers,
we
seek
to
maximize
access
to
the
highest
quality
of
care.
Insurance
companies
hold
the
market
power
and
use
it
to
restrict
patient
choice,”
the
statement
read.
The
lawsuit
could
mark
an
apparent
crackdown
on
hospitals’
payer
contracting
practices,
given
the
Justice
Department
filed
a
similar
antitrust
lawsuit
against
OhioHealth
five
weeks
ago.
The
case
centers
on
the
alleged
use
of
“all-or-nothing”
contracts
that
force
payers
to
include
every
hospital
and
physician
affiliated
with
OhioHealth
in
their
networks.
Depending
on
the
rulings,
these
cases
could
reshape
how
large
health
systems
negotiate
with
payers,
potentially
giving
patients
and
employers
more
options.
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