Justice Department 'upping its game' on healthcare antitrust enforcement with new task force

The U.S. Department of Justice (DOJ) announced Thursday it has established a new task force to take on healthcare monopolies and collusion.

The task force, called HCMC for short, will guide the division’s enforcement strategy and policy approach in healthcare, including by facilitating policy advocacy, investigations and, where warranted, civil and criminal enforcement in healthcare markets, the agency said in a press release.

The task force will consider "widespread competition concerns" shared by patients, healthcare professionals, businesses and entrepreneurs, including "issues regarding payer-provider consolidation, serial acquisitions, labor and quality of care, medical billing, healthcare IT services and access to and misuse of health care data," the DOJ said.

“Every year, Americans spend trillions of dollars on health care, money that is increasingly being gobbled up by a small number of payers, providers and dominant intermediaries that have consolidated their way to power in communities across the country,” said Assistant Attorney General Jonathan Kanter of the DOJ’s Antitrust Division, in a statement.

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 healthcare industry, Kanter said.

The task force will be headed by longtime antitrust prosecutor Katrina Rouse, who joined the Antitrust Division in 2011. 

Rouse previously served as chief of the division’s Defense, Industrials, and Aerospace Section, assistant chief of the division’s San Francisco office, a special assistant U.S. attorney and a trial attorney in the division’s Healthcare and Consumer Products Section. 

The HCMC will bring together civil and criminal prosecutors, economists, healthcare industry experts, technologists, data scientists, investigators and policy advisers from across the division’s civil, criminal, litigation and policy programs, and the expert analysis group, to "identify and address pressing antitrust problems in healthcare markets."

"The purpose of this task force is to ensure that we are taking a whole-of-division approach as well as a whole-of-government approach to ensure that we hold monopolies and bad actors accountable for violations of the antitrust laws in the healthcare space," Kanter said in a video interview with The Washington Post on Thursday.

"Healthcare in a post-industrial economy is different than it used to be. No longer do we just have markets where you have separate lines of commerce with doctors or a hospital or an insurance company. Today, we experience healthcare as platforms. The platformization of healthcare has resulted in multi-sided giants, intermediaries that have a coordinated stack of businesses that flow together, including payers, including providers, including PBMs, claims processing, banks, these are multi-sided giants that are accumulating assets at an alarming rate and are becoming the new intermediaries and gatekeepers of our healthcare system," Kanter said in the interview.

He added, "It's really important that we adjust to market realities and make sure that we have not only the resources devoted to addressing these concerns, but have the expertise devoted."

Kanter said the DOJ has resources and tools within its Antitrust Division to bring to bear, including its civil merger program, a monopolization program, a "criminal antitrust enforcement against cartels and collusion" and a "deep bench of experts, including economists and data scientists" to ensure that the agency is "addressing the market realities as they exist today," Kanter said.

He added, "Today's announcement essentially explains that we are upping our game and we are going to elevate the importance of healthcare antitrust enforcement. It is among our highest priorities because this is not just about dollars and cents. Healthcare is not just about making money. It's about lives. When you ask people what keeps them up at night, affording healthcare is too often at the top of the list," he said. "Making sure that doctors have the ability to provide a quality level of care necessary to take care of our loved ones. These are real issues that affect real people and we are organizing ourselves to make sure we can meet that moment."

Lawmakers and regulators have stepped up scrutiny of corporate interests and ownership in healthcare. There have been sweeping efforts quarterbacked by the White House and involving federal agencies and regulators to focus on anticompetitive behaviors. On Capitol Hill, the Senate Budget Committee is investigating reports that private equity ownership of healthcare providers has contributed to deteriorating care.

Last month, all 11 of Massachusetts’ federal legislators called on regulators to keep a short leash on UnitedHealth Group’s proposed acquisition of Steward Health Care’s physician group.

In a recent letter, lawmakers told the Federal Trade Commission and the DOJ's Antitrust Division’s heads to keep a sharp eye on UnitedHealth Group’s Optum, which already has “a stranglehold over U.S. physicians.”    

The Wall Street Journal also reported in February that the Biden administration is launching an antitrust probe into UnitedHealth Group.

The news outlet reported that investigators with the DOJ have conducted interviews in the segments where UnitedHealth competes, including physician groups. Sources told the WSJ that these interviews have included questions about the relationship between UnitedHealthcare and Optum.

During two congressional hearings last week looking into the massive cyberattack on Change Healthcare, which is owned by UnitedHealth Group, lawmakers raised concerns about the company's size and scope. Multiple senators described UnitedHealth as "too big to fail."

When asked by The Washington Post during the video interview whether he agreed with the sentiment of some lawmakers that United Healthcare had gotten so big that it poses a national security risk, Kanter said: “I can’t talk about specific companies or specific investigations, but I do want to say more generally that monopolies and concentration of power don’t just create risk to consumers in terms of higher prices or in the case of healthcare, a more expensive healthcare and access to life-saving treatments and medicine. But it is a resiliency risk … When certain large entities are controlling so much of our healthcare decision-making, our healthcare system, whether it is at the insurance level or the doctor level or the provider level or the data level, it creates often sitting ducks for cyber risks … It can also create strong entities with deep incentives to put profits ahead of people.”