A union health and welfare benefit fund filed a class action antitrust lawsuit Aug. 19 against Columbus-based OhioHealth, alleging the system’s contracts with insurers blocked lower-cost plan designs and inflated what payers paid for care, according to court documents accessed by Becker’s.
Five things to know:
1. Cleveland Bakers and Teamsters Health and Welfare Fund filed the complaint in the U.S. District Court for the Southern District of Ohio. The self-funded union health plan covers about 10,000 people and said it paid about $1.2 million to OhioHealth over the past four years at prices it alleges were inflated.
2. The suit alleges OhioHealth used its position in Central Ohio to impose contract terms that blocked or penalized steering, tiering and narrow networks, and required network vendors to include all OhioHealth facilities and providers if they wanted to include any of them. The complaint brings claims under the Sherman Act, Ohio’s Valentine Act and unjust enrichment under Ohio common law, and seeks treble damages and an injunction.
3. The fund alleges the contract provisions limited insurers’ ability to steer patients toward lower-cost providers and prevented employers and health plans from designing narrower or tiered networks that could exclude higher-cost OhioHealth facilities. The complaint alleges those restrictions reduced competition and resulted in higher healthcare costs for health plans and their members.
4. Becker’s asked OhioHealth for additional context and responses to specific allegations raised in the complaint. “We are confident in our position and dispute the allegations in this lawsuit,” a system spokesperson told Becker’s. The system declined to comment beyond this statement.
5. The filing follows a February lawsuit filed by the Justice Department and Ohio’s attorney general over similar conduct. OhioHealth settled that case in June with no fine or admission of wrongdoing, agreeing to remove certain contract provisions under court supervision.
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