Womble Perspectives
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Womble Perspectives
DOJ Launches Task Force to Tackle Health Care Monopolies and Collusion
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The Antitrust Division of the Department of Justice has made a bold move in its ongoing effort to ensure fair competition within the healthcare industry with the announcement of the Task Force on Health Care Monopolies and Collusion on May 9.
According to Assistant Attorney General Jonathan Kanter, "The task force will identify and root out monopolies and collusive practices that increase costs, decrease quality, and create single points of failure in the health care industry.”
Read the full article.
About the authors
Luke Cass
Lee K. Van Voorhis
Matthew L. Hickman
Welcome to womble perspectives, where we explore a wide range of topics, from the latest legal updates to industry trends to the business of law. Our team of lawyers, professionals and occasional outside guests will take you through the most pressing issues facing businesses today and provide practical and actionable advice to help you navigate the ever changing legal landscape.
With a focus on innovation, collaboration and client service, we are committed to delivering exceptional value to our clients and to the communities we serve. And now our latest episode.
The Antitrust Division of the Department of Justice has made a bold move in its ongoing effort to ensure fair competition within the healthcare industry with the announcement of the Task Force on Health Care Monopolies and Collusion on May 9.
According to Assistant Attorney General Jonathan Kanter, "The task force will identify and root out monopolies and collusive practices that increase costs, decrease quality, and create single points of failure in the health care industry.” This initiative aligns with the Biden Administration's broader scrutiny of business practices that potentially violate antitrust laws, marking a significant step forward in healthcare regulation.
The Health Care Monopolies and Collusion Task Force is a multi-disciplinary team composed of civil and criminal prosecutors, economists, healthcare experts, technologists, data scientists, investigators, and policy advisors. This collective expertise will enable the task force to tackle complex issues within the healthcare industry effectively.
The task force will employ both civil and criminal investigative techniques, relying heavily on data analytics to identify unfair competition. This "whole-of-division" and "whole-of-government" approach aims to leverage the combined resources of multiple government agencies to address antitrust concerns comprehensively.
One of the task force's primary targets will be vertically integrated "payviders"—entities that combine various components of the healthcare ecosystem, including payors, providers, pharmacy benefit managers, claims processors, and even banks. This "platformization" of healthcare creates multi-sided giants that can exert undue influence over the market, stifling competition and innovation.
Another focus will be on entities that rapidly acquire multiple healthcare assets, effectively becoming gatekeepers within the industry. These entities can limit competition by controlling access to essential healthcare services and resources, leading to higher costs and reduced quality of care.
The Health Care Monopolies and Collusion Task Force will collaborate with various government agencies to employ multiple investigative tools and address anti-competitive behavior effectively. This cross-agency approach ensures a comprehensive examination of the healthcare industry's practices, aiming to uncover and penalize any misconduct.
The formation of the task force signals increased scrutiny of healthcare entities, particularly those involved in mergers and acquisitions and vertically integrated operations.
Healthcare entities engaging in M&A activities must prioritize due diligence and compliance to mitigate risks. The DOJ's recent safe harbor guidelines for voluntary self-disclosure of issues discovered during M&A transactions emphasize the importance of thorough assessment and integration of compliance professionals in these processes.
Healthcare organizations must ensure their billing and care practices align with industry standards and best practices. Regular internal audits and reviews of business operations can help identify and address potential areas of concern, reducing the risk of DOJ intervention.
Data analytics will play a crucial role in the task force's investigations. Healthcare entities must leverage data analytics to monitor patient care and ensure it aligns with best practices and industry standards. This proactive approach can serve as a strong defense against potential enforcement actions.
To navigate the increased scrutiny and stay compliant, healthcare stakeholders should consider
assessing due diligence practices and involve compliance professionals to identify and mitigate risks during M&A transactions. Ensuring thorough evaluation of potential acquisitions can prevent future regulatory issues.
In addition, conduct regular reviews of your billing practices and ensure they align with industry best practices. Internal audits can help preemptively address potential concerns and demonstrate a commitment to compliance.
Also, use data analytics to monitor patient care and ensure it meets industry standards. This proactive approach can help identify and address issues before they attract regulatory attention.
And don't forget to understand the incentives for whistleblowers and self-disclosure programs. Consulting legal counsel to address potential issues quickly is crucial to navigating enforcement timelines and compliance requirements effectively.
The actions of the Health Care Monopolies and Collusion Task Force are likely to have significant implications for the healthcare industry.
The focus on monopolistic and collusive practices will likely lead to increased enforcement actions and penalties. Healthcare entities must remain vigilant and proactive in their compliance efforts to avoid regulatory issues.
As the task force uncovers and addresses anti-competitive behavior, industry standards and best practices are likely to evolve. Healthcare organizations must stay informed about regulatory developments and adapt their practices accordingly.
Healthcare businesses should also consider taking strategic steps to ensure compliance and mitigate risks, including investing in compliance programs, conducting regular audits, and leveraging data analytics to monitor and improve patient care.
The DOJ's new Task Force on Health Care Monopolies and Collusion represents a significant step forward in addressing anti-competitive practices within the healthcare industry. By focusing on multi-sided giants, rapid accumulation of healthcare assets, and collaboration with other government agencies, the task force aims to create a fair and competitive healthcare landscape.
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