In its suit, Methodist claims OSF has engaged in anticompetitive and exclusionary conduct affecting “several major commercial insurers” that violates federal antitrust laws as well as provisions of Illinois law.
“Saint Francis has an approximate 53 percent share of the market for inpatient hospital services sold to commercial health insurers and a greater than 50 percent share of the market for outpatient surgical services sold to commercial health insurers,” says the complaint.
“Commercial health insurers in the relevant geographic market consider Saint Francis a ‘must-have’ hospital for health plans because it is by far the largest hospital in the region and the only local provider of certain essential services, including tertiary pediatric services.”
The lawsuit claims Saint Francis has used its “must-have” status to force commercial health insurers to enter contracts that exclude its most significant competitors. Methodist alleges that Saint Francis has threatened to withdraw from a commercial insurer’s network, taking essential services and other OSF hospitals with it, or impose a pricing penalty if insurers include a competing provider within the network.
“We are taking this step only after many years of attempting to resolve the situation without legal action, including a recent conversation with OSF leaders,” Debbie Simon, president and CEO of Methodist Health Services, said in the release.
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