On March 26, 2026, the US Department of Justice Antitrust Division (DOJ) brought a civil action against New York-Presbyterian Hospital (NYP) in the United States District Court for the Southern District of New York alleging that NYP violated Section 1 of the Sherman Act through allegedly restrictive contracts with anti-steering provisions. DOJ alleges that NYP’s actions have stifled competition and artificially inflated healthcare costs in the New York City area. This complaint closely tracks the suit brought by DOJ and the Ohio AG against OhioHealth last month (see our prior blog post for more background).
Key Takeaways
- Healthcare contracting under the microscope. As with DOJ and the Ohio AG’s complaint last month against OhioHealth, the allegations against NYP focuses on large hospital systems’ use of restrictive contracting, signaling that this is a top priority for enforcers.
- Continued emphasis on civil enforcement after lull. The lawsuit, the second civil conduct enforcement action following more than a year-long pause, signals DOJ’s renewed commitment to bringing civil cases in line with Acting Assistant Attorney General (AAG) Omeed Assefi’s stated goal of ramping up civil antitrust enforcement.
- Sustained focus on “pocketbook” issues. DOJ’s action against NYP, echoing its approach in the OhioHealth case, underscores its continued focus on healthcare and “pocketbook” issues, aligning with the Trump administration’s “America First Antitrust” guidance by prioritizing industries where competition directly affects everyday household costs, and we expect this trend to continue.
Background of the Case
According to the complaint, NYP has market power in the provision of inpatient general acute care (GAC) hospital services in both the Manhattan and a broader Four-Borough area (excluding Staten Island). DOJ alleges that NYP commands a market share of 30% in Manhattan and more than 25% in the Four-Borough area (Bronx, Brooklyn, Manhattan, Queens). NYP allegedly uses its relative size to restrict the ability of commercial health insurers to design and offer lower-cost health plans.
DOJ alleges that NYP restricted competition with its rival hospitals through a variety of contractual provisions with insurers, including requirements that NYP be included in almost all networks for commercial insurance products and that NYP be featured at the most favored level of benefits in each plan. Similarly, in OhioHealth, DOJ and the Ohio AG alleged that OhioHealth employed comparable “all-or-nothing” contracting terms and most-favored-tier provisions to achieve the same anticompetitive effect. According to the complaint, these provisions effectively require insurers to include all NYP facilities in their networks because they cannot viably operate in New York City without at least one NYP-inclusive plan. This tactic allegedly prevents insurers from offering more cost-effective insurance plans that feature NYP’s rivals.
As a result of NYP’s contract provisions and practices, DOJ argues that these restrictions prevent lower-cost healthcare providers from competing to attract patients by lowering their own prices or investing in quality improvements. DOJ alleges that NYP’s conduct increases healthcare costs and reduces choices for patients and employers in New York City.
Looking Ahead
The NYP action suggests that DOJ’s renewed civil conduct enforcement push in healthcare is likely to continue, with more significant providers facing heightened scrutiny of contracting terms that may limit insurer flexibility. As DOJ re-engages on civil conduct cases, hospitals and insurers should expect sustained attention to anti-steering, plan-design restrictions, and other provisions that the agency views as barriers to lower-cost insurance options.
