White House and DOJ Gain Early Traction in Campaign Against Restrictive Hospital-Payor Contract Terms With OhioHealth Settlement

Hospital-payor contracts have become a focus in the Trump administration’s effort to address rising inpatient hospital costs. In a new White House report, and as demonstrated by recent Department of Justice (DOJ) enforcement actions against hospitals and health systems, there is a clear signal that the administration is prepared to pursue what it views as anticompetitive healthcare contracting practices through both policy and enforcement channels. Considering these developments, hospitals, health systems, payors, and other industry participants should pay close attention to contracting practices that may limit patient choice or prevent lower-cost plan designs.

I. White House Report Targets Restrictive Payor Contracts

The White House’s Council of Economic Advisors (CEA) recently released a report outlining the administration’s economic rationale for targeting certain provisions in commercial hospital-payor contracts.¹ The report argues that dominant hospital systems leverage their “must have” status in payor negotiations to preserve market power, raise healthcare costs, and limit price competition through restrictive contracting practices. Specifically, the CEA analyzes three types of provisions:

• Anti-Steering: Provisions that limit payors’ ability to offer patients financial incentives such as lower co-pays or reduced deductibles for choosing lower-cost providers
• Anti-Tiering: Provisions that require payors to place a hospital system in the most favorable cost-sharing tier regardless of price, limiting the payor’s ability to use plan design to incentivize patients to use hospitals that are lower cost from the payor’s perspective
• All-or-Nothing Contracting Provisions: Provisions that require payors to contract with all of a system’s hospitals and affiliated providers or none of them, which hospital systems often seek to avoid challenges with out-of-network billing by affiliated providers who support the system, limiting selective contracting or network construction and making it harder for competing hospitals and providers to attract sufficient patient volume

The CEA analysis finds that banning these types of participating provider agreement provisions could lower costs through various mechanisms, including improving payor bargaining leverage to reduce payments to hospitals, shifting patients toward lower-cost hospitals, and improving competition by strengthening smaller, rival hospital systems. The CEA estimates that a nationwide ban could reduce hospital and physician prices by as much as 18% in certain geographic markets and lower commercial employer-sponsored insurance premiums by approximately 6.5%. According to the report, these benefits would be concentrated in markets with dominant hospital systems where these contracting provisions are more prevalent. From the perspective of affected hospital systems, however, eliminating these provisions could cut already constrained operating budgets for academic medical centers and other large regional health systems that rely on commercial reimbursement to help subsidize charity and other uninsured care.

II. DOJ Secures Settlement Ending OhioHealth’s Use of Restrictive Contracting Provisions

The CEA report follows closely on the heels of the DOJ Antitrust Division securing a favorable settlement in its own enforcement action targeting similar types of restrictive contract provisions. On June 16, 2026, the DOJ and the State of Ohio announced a proposed settlement with OhioHealth to resolve an antitrust lawsuit alleging that OhioHealth used restrictive payor contract provisions to maintain its dominant market position, suppress competition, and increase healthcare costs for Ohio patients. Once finalized, the settlement will prohibit OhioHealth from using many of these provisions in payor contracts and may serve as a road map for the DOJ’s approach to similar contracting practices, including those at issue in its pending lawsuit against NewYork-Presbyterian, discussed in more detail below.

a. DOJ’s Allegations of Anticompetitive Contracting Practices

In February 2026, the DOJ and Ohio attorney general sued OhioHealth in the U.S. District Court for the Southern District of Ohio, alleging that OhioHealth used its market power to impose contractual restrictions that limited payors’ ability to offer innovative, lower-cost health insurance plans or plan features, in violation of Section 1 of the Sherman Act and corresponding state law.² The complaint sought to enjoin OhioHealth from enforcing the challenged provisions and continuing to suppress healthcare competition.

OhioHealth operates a large network of 16 hospitals across Ohio and, according to the complaint, is the “dominant hospital system in the Columbus area,” providing more than 35% of inpatient hospital services. OhioHealth’s alleged market dominance makes it a “must have” hospital, and payors cannot market a commercially viable health plan in central Ohio without including key OhioHealth facilities in their networks. OhioHealth allegedly used this leverage to force payors to accept anticompetitive contract provisions — including anti-steering, anti-tiering, and all-or-nothing bundles — to limit the payors’ ability to introduce lower-cost plans. The complaint also argued that OhioHealth’s payor contracts limited price transparency by preventing payors from providing patients with needed pricing information. The DOJ argued that these restrictions left Ohio patients and employers with fewer health plan choices and higher healthcare costs.

b. DOJ Settlement With OhioHealth

The proposed settlement resolves the DOJ’s and Ohio attorney general’s lawsuit against OhioHealth without any admission of liability or financial penalty. Instead, it provides injunctive relief requiring OhioHealth to modify its contracting practices going forward. The primary components of the settlement include requiring OhioHealth to eliminate provisions that prohibit or discourage payors from providing price transparency or offering lower-cost or innovative health plans, including narrow networks, tiered networks, and other plans that offer patients a lower-cost alternative; prohibiting OhioHealth from negotiating or obtaining comparable terms in future agreements with commercial payors; and preventing OhioHealth from retaliating against payors that offer lower-cost or alternative plan designs.

The settlement also imposes ongoing reporting and compliance obligations that an independent monitor oversees for five years and requires OhioHealth to submit regular compliance reports to the DOJ. Further, OhioHealth must notify payors that the challenged provisions are unenforceable.

c. Implications for Pending DOJ Suit Against NewYork-Presbyterian Hospital

The OhioHealth settlement has significant implications for the DOJ’s ongoing challenge to NewYork-Presbyterian Hospital’s (NYP) alleged restrictive payor contracting practices. The DOJ, together with the U.S. Attorney’s Office for the Southern District of New York, brought a lawsuit against NYP in March 2026, approximately one month after the OhioHealth complaint and with substantially similar allegations.³ Both cases are premised on the theory that dominant hospital systems used restrictive contract provisions to limit payors’ ability to offer lower-cost network designs and steer patients to competing providers. In its lawsuit against NYP, the largest hospital system in New York City with eight hospitals and numerous outpatient facilities, the DOJ similarly alleges that NYP leveraged its market power to impose anti-tiering and anti-steering provisions in its payor contracts. According to the DOJ’s complaint, these contracting practices insulate NYP from price competition, deny competing providers the opportunity to compete for patients based on lower prices or better value, and prevent the development of lower-cost healthcare plans for New Yorkers.

Although the DOJ’s legal theory remains untested in court, the OhioHealth settlement provides an early indication of the remedies the DOJ is likely to seek in its case against NYP and may increase pressure on NYP to pursue a settlement rather than protracted litigation.

III. Key Takeaways

In sum, the CEA report and the DOJ’s actions against OhioHealth and NYP signal a coordinated effort by the Trump administration to expand healthcare antitrust enforcement beyond mergers and acquisitions to encompass contracting practices by dominant health systems. The OhioHealth settlement provides the first concrete blueprint for the conduct-based remedies the DOJ is likely to pursue in future cases, including its pending lawsuit against NYP. More broadly, these two cases underscore that scrutiny of hospital and health system contracting practices — including anti-steering, anti-tiering, and all-or-nothing contracts — remains a significant federal antitrust enforcement priority.

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The Goodwin Healthcare team will continue to monitor developments in healthcare antitrust matters. For more information on the issues discussed in this alert, please contact the authors or reach out to Goodwin’s Healthcare Regulatory and Compliance group, Antitrust & Competition group, or the Goodwin lawyer with whom you typically consult.

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