Feds launch new web portal to report unfair competition in health care

_{© Federal Trade Commission}

Federal regulators want to make it as easy as a mouse click to report instances of unfair competition in health care.

A new online portal, HealthyCompetition.gov, allows physicians or anyone to report suspicions of unfair and anticompetitive practices. It is a joint project of the Federal Trade Commission (FTC) and the U.S. Departments of Justice (DOJ) and Health and Human Services (HHS). Those agencies, and the administration of President Joe Biden, aim to create more competitive market conditions fairer to physicians, patients, payers and workers, according to the official announcement.

“All too often, we hear how unfair methods of competition and monopolistic practices may be depriving Americans of access to affordable, high-quality health care,” FTC Chair Lina M. Khan said in the announcement. “This joint initiative between, FTC, DOJ, and HHS will provide a crucial channel for the agencies to hear from the public, bolstering our work to check illegal business practices that harm consumers and workers alike.”

“Everyone deserves access to a competitive health care marketplace,” the website said. “If you need medical care, fair competition helps lower the price you pay and improve the quality of your care. If your job is in health care, competition helps you get a fair wage and opportunities to grow.”

The website noted complaints should be specific to health care competition. The federal agencies will not consider complaints about failure to pay claims or about coverage, insurance rates, billing disputes, “or general unhappiness about the health care system.” Complaints may be anonymous, or those seeking action can include contact information.

What’s online

The new portal includes a summary of federal laws that aim to promote market competition for business, such as the Sherman Act, which bars companies from creating monopolies. There is a section with descriptions and examples of potentially anticompetitive actions. The headers are:

• Consolidation, Joint Ventures and “Roll-ups” of Healthcare Providers or Companies
• Limiting Choice and Fair Wages for Healthcare Employees
• Collusion or Price Fixing Among Competitors
• Preventing Transparency
• Healthcare Contract Langauge and other Practices That Restrict Competition
• Anticompetitive Uses of Healthcare Data
• Unnecessary Healthcare Provider Recertification or Accreditation Requirements

Examples with physicians

Descriptions and examples appear to aim at hospitals, health systems, private equity investors, insurers, pharmaceutical companies and pharmacy benefit managers. Some include business deals involving physicians. For example, it may be anticompetitive if:

• “A hospital system that buys a large practice that does a lot of patient referrals,” then has lower incentives to compete.
• “A health insurance company buys several medical practices that compete with each other. It also prohibits its medical practices from contracting with rival health insurance companies.”
• “A health system revokes a physician’s medical staff privileges for having ownership in a competing facility.”
• Anti-tiering and anti-steering contract language can occur when a hospital system requires and insurer to put all its physicians, hospitals and facilities in the most favorable tier of providers, or use the lowest cost-sharing rate so patients do not go to other providers.

Upon further review

Staff at the FTC and DOJ’s Antitrust Division will review complaints and may select them for further investigation, and possible opening of a formal investigation, by the appropriate agency.

“Americans depend on competitive health care markets to provide quality choices and lower costs for coverage. That’s why we are working to tackle anticompetitive practices in the health care markets,” HHS Secretary Xavier Becerra said in the FTC’s news release. “The Biden-Harris Administration and HHS know it is our responsibility to stop monopolistic, anti-competitive practices that undermine the delivery of health care to Americans. The information provided by the public will help to root out these behaviors.”