Antitrust Division Challenges the Contracting Practices at Another Major Hospital Network

Continuing its trend of robust enforcement in health care markets, the U.S. Department of Justice Antitrust Division filed a complaint under Section 1 of the Sherman Act against The New York and Presbyterian Hospital in the U.S. District Court for the Southern District of New York on March 26, 2026. The complaint alleges that New York‑Presbyterian—one of the largest hospital systems in New York City—has engaged in anticompetitive contracting practices that increase health care costs and restrict consumer choice.

The complaint alleges that New York‑Presbyterian, with eight general acute care hospitals in the New York City area, has unlawfully restrained competition by imposing so‑called “all‑or‑nothing” contractual provisions on commercial health insurers, requiring insurers to include all New York‑Presbyterian hospitals and facilities in nearly every insurance product offered or risk losing access to the system entirely.

DOJ contends that these restrictions prevent insurers, employers and unions from offering budget‑conscious or narrower‑network health plans that steer consumers away from higher-priced New York-Presbyterian and from using cost‑sharing tools—such as lower copays—to allow patients to use lower‑priced competing hospitals. 

Claims of Market Power with Lower Market Shares

The Division alleges that New York‑Presbyterian has market power, based on its ownership of eight hospitals, numerous outpatient facilities and a substantial share of inpatient acute‑care services in Manhattan and the four boroughs of New York City excluding Staten Island. (DOJ contends that NY patients do not consider hospitals located on Staten Island to be a close substitute to hospitals in the other four boroughs of NYC.) 

Specifically, DOJ claims New York‑Presbyterian has more than 30 percent market share in Manhattan and more than 25 percent in the four boroughs. Both percentages are lower than what DOJ has historically asserted as sufficient market share to demonstrate market power, indicating a more aggressive approach to enforcement in health care markets.

According to DOJ, market power allows New York‑Presbyterian to command prices significantly higher than those of competing hospital systems, including NYU Langone and Mount Sinai, despite offering comparable quality of care.

The Antitrust Division alleges that insurers have been unable to resist the challenged contractual provisions because excluding New York‑Presbyterian from their networks would render their insurance products commercially unviable.

The Division’s complaint cites several internal NYP business documents as admissions that the hospital network has market power, including one noting that “[n]otwithstanding national and local trends to the contrary, [New York‑Presbyterian] retained the Hospitals’ … terms and conditions that protect against administrative erosion of rates of payment or steerage away from the Hospitals.”

Anticompetitive Conduct Targeting Budget Conscious Plans

The Division alleges that New York-Presbyterian forces payors to include it in all networks and feature it as the most-favored level of benefit in each plan offered, which prevents insurers from offering budget conscious plans that they offer in other partes of the United States.

Because the “all‑or‑nothing” New York‑Presbyterian contracts, insurers cannot offer tiered-network plans (with lower co-insurance payments for using lower-priced providers), or “center of excellence” providers who provide high-value care at lower costs, or site-of-service steering plans that incentivize patients to choose lower-cost locations (e.g., ambulatory surgery centers) for certain care.

DOJ alleges that New York‑Presbyterian has calculated that if payors could introduce tiered plans and other forms of steering patients to lower-priced care, it would reduce the hospital network’s profits by hundreds of millions of dollars.

Behavioral Remedies Sought

The Division seeks injunctive relief prohibiting New York‑Presbyterian from enforcing the challenged contract provisions and from entering into similar agreements in the future. The complaint requests relief designed to restore competition among hospitals, enable the development of lower‑cost and tiered health insurance products and reduce health care costs for New Yorkers.

A New Era of Antitrust Scrutiny of Hospital Contracting Practices

This lawsuit is the Antitrust Division’s second civil hospital contract enforcement action in 2026, following its recent and similar to OhioHealth’s insurer contract practices with the Ohio Attorney General.

Acting Assistant Attorney General Assefi stated “New York-Presbyterian has known for years that the American consumer wants budget-conscious health plans that reduce healthcare costs. But rather than offer consumers choice, New York-Presbyterian uses its market power to protect its margins, impede competition from rival hospitals, and prevent employers and unions from creating these plans.”

The case demonstrates the DOJ’s continued focus on health care markets and signals heightened antitrust scrutiny of dominant health care systems whose payor agreements are viewed as restricting insurer design, consumer choice or price competition, similar to the Division’s lawsuit from a decade ago challenging the contracting practices of Carolinas HealthCare System.

Press Release, U.S. Dep’t of Just., Justice Department Sues OhioHealth for Anticompetitive Healthcare Contracts That Increase Costs for Ohio Patients (Feb. 20, 2026), .

Press Release, U.S. Dep’t of Just., Justice Department Sues New York-Presbyterian Hospital for Anticompetitive Contracts That Increase Healthcare Prices for New Yorkers (Mar. 26, 2026),

Press Release, U.S. Dep’t of Just., Atrium Health Agrees to Settle Antitrust Lawsuit and Eliminate Anticompetitive Steering Restrictions (Nov. 15, 2018), .