DOJ unveils task force on healthcare monopolies

Photo: Matt Mawson/Getty Images

The U.S. Department of Justice has announced the formation of the Antitrust Division's Task Force on Health Care Monopolies and Collusion (HCMC), which will guide the division's enforcement strategy and policy approach in healthcare.

This will include facilitating policy advocacy, investigations and, where warranted, civil and criminal enforcement in healthcare markets.

"Every year, Americans spend trillions of dollars on healthcare, money that is increasingly being gobbled up by a small number of payers, providers and dominant intermediaries that have consolidated their way to power in communities across the country," said Assistant Attorney General Jonathan Kanter of the Justice Department's Antitrust Division.

The task force is intended to identify and root out monopolies, as well as any collusive practices that increase costs and decrease quality, according to the DOJ.

WHAT'S THE IMPACT

The HCMC will consider widespread competition concerns shared by patients, healthcare professionals, businesses and entrepreneurs, including issues regarding payer-provider consolidation, serial acquisitions, labor and quality of care, medical billing, healthcare IT services, and access to and misuse of healthcare data.

The task force will also bring together civil and criminal prosecutors, economists, healthcare industry experts, technologists, data scientists, investigators and policy advisors from across the division's Civil, Criminal, Litigation and Policy Programs, and the Expert Analysis Group to identify and address pressing antitrust problems in healthcare markets.

The HCMC will be directed by Katrina Rouse, a long-serving antitrust prosecutor who joined the Antitrust Division in 2011. She previously served as chief of the division's Defense, Industrials and Aerospace Section, assistant chief of the division's San Francisco office, and a special assistant U.S. attorney and a trial attorney in the division's Healthcare and Consumer Products Section.

Rouse holds degrees from Columbia University and Stanford Law School, and has clerked for federal judges in the U.S. District Court for the District of Maryland and the U.S. Court of Appeals for the Fifth Circuit. She will also serve as the division's deputy director of civil enforcement and special counsel for healthcare.

The Antitrust Division said it welcomes input from the public, including from practitioners, patients, researchers, business owners and others who have direct insight into competition concerns in the healthcare industry.

Where appropriate, the division will refer matters to other federal and state law enforcers, the DOJ said.

Members of the public can share their experiences with the task force by visiting HealthyCompetition.gov.

THE LARGER TREND

Healthcare monopolies, which can be spurred by hospital consolidation, could have a detrimental effect on consumers' premiums and out-of-pocket spending due to the resulting outpatient facility fees, a 2023 report found.

Consumer advocates, payers and state regulators flagged a range of issues related to outpatient facility fees. Both consumer advocates and regulators expressed concerns about the financial exposure facility fees created for consumers via increased out-of-pocket spending – driven by plans with high deductibles and other benefit design features that increase patients' exposure to cost-sharing – and higher premiums resulting from increased spending on ambulatory services.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.