DOJ and Ohio AG Sue Ohio Hospital Network for Anticompetitive Contracting Practices

In the latest example of antitrust enforcers staying aggressive in health care markets, the U.S. Department of Justice (DOJ) Antitrust Division and the Ohio Attorney General (AG) sued OhioHealth Corporation—one of the largest health care systems in Ohio and the largest provider in the Columbus area—in February 2026 for anticompetitive contracting practices in the market for general acute care inpatient hospital services in the Columbus, Ohio area, in violation of Section 1 of the Sherman Act and the Ohio Valentine Act.

The Antitrust Division and Ohio AG allege that OhioHealth unlawfully restrained competition by imposing contractual provisions, including anti-steering provisions and all-or-nothing contracting on commercial health insurers that require inclusion of all OhioHealth’s providing hospitals and physicians in all insurance products, regardless of price.

The lawsuit contends that restricting insurer competition increases health care costs for patients and employers by preventing insurers and other payors from offering “budget-conscious” or narrower‑network health plans, thereby depriving patients and employers of choice and access to lower‑priced alternatives to OhioHealth’s providers. The complaint further alleges that these restrictions inflate insurance premiums and increase out‑of‑pocket costs.

The DOJ and the Ohio AG also assert that OhioHealth’s restrictions prevent lower-cost health care providers from competing for patient volume through lower rates. Without larger patient volume, OhioHealth’s competitors cannot invest in new services or expand, raising barriers to entry.

Relevant Market and Market Power (But No Monopoly Power)

The DOJ and AG complaint claims that OhioHealth has market power in the Columbus-area market for inpatient general acute care services, with 16 hospitals and outpatient facilities accounting for more than 35% of discharges and bed capacity. OhioHealth has two significant competitors in Columbus, specifically the Ohio State University Wexner Medical Center and Mount Carmel Health System, owned by Trinity Health, which likely explains why there is no monopolization claim under Section 2 of the Sherman Act.

Anticompetitive Conduct: Gag Rules and MFNs

The DOJ and the AG allege that OhioHealth’s market “dominance” has enabled it to “ward off competition” and negotiate reimbursement rates substantially higher than those of competing providers by requiring that OhioHealth receive the most favored level of benefits in each payor’s network and imposing “gag rules” on payors preventing them from informing patients about lower priced health care services. 

Insurers allegedly attempted to negotiate the removal of the challenged provisions but ultimately acquiesced because OhioHealth refused to modify its contracts. Because of OhioHealth’s size, insurers and other payors could not feasibly exclude the OhioHealth system from their networks and still offer viable insurance products.

Behavioral Remedies Sought

Through their lawsuit, the antitrust enforcers seek injunctive relief prohibiting OhioHealth from enforcing the challenged restrictions on budget-conscious plans, from prohibiting payors from giving patients information or incentives to use lower-cost providers, and from entering into similar agreements in the future.

Analysis: Health Care Antitrust Enforcement Still a Priority

This case reflects the Antitrust Division’s renewed focus on health care affordability and competition. Acting Assistant AG Assefi remarked that OhioHealth’s contract restrictions “cause many Columbus residents to pay more for lower-quality healthcare” and that “American families and consumers deserve better.”

As a result, health care systems with significant regional market share may face increased antitrust risk where their payor agreements are viewed as limiting consumer choice or impeding the development of lower-cost insurance products.

Not including settlements, the lawsuit marks the Antitrust Division’s first civil enforcement action in approximately a year and came just one week after Omeed Assefi replaced Gail Slater as the leader of the Antitrust Division.

The allegations against OhioHealth mirror those raised against Sutter Health, where plaintiffs in California alleged that Sutter leveraged its market power to impose all-or-nothing insurer contract provisions that foreclosed competition and drove higher health care prices. Those allegations ultimately resulted in two significant antitrust settlements. In the consolidated state court action, Sutter agreed to pay $575 million and to long‑term injunctive relief limiting its insurer contracting practices, while in parallel private litigation in federal court Sutter also settled class action claims brought by premium‑paying purchasers for an additional $228.5 million.

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