1. Home
  2. |Insights
  3. |DOJ Antitrust Settlement Requires North Carolina Physician Group To Disband

DOJ Antitrust Settlement Requires North Carolina Physician Group To Disband

Client Alert | 1 min read | 12.15.02

On December 13th, the Antitrust Division of the Department of Justice announced that it will require Mountain Health Care, an independent physicians organization headquartered in Asheville, North Carolina, to cease its operations and dissolve. The Department said that under a proposed settlement, Mountain Health Care will cease negotiating and contracting with health care plans on behalf of its participating physicians, a practice DOJ said resulted in consumers paying increased prices to Mountain Health Care's physician members for health care services.

Click here for the DOJ complaint, stipulation to final judgment, and competitive impact statement.

According to the DOJ complaint filed in federal district court in connection with the settlement, Mountain Health Care restrained price and other forms of competition among physicians in Western North Carolina by adopting a uniform fee schedule for its physicians. Mountain Health Care agreed to contracts with managed care purchasers that incorporated the collectively set fees. These actions resulted in higher rates charged to health plans leading to higher health costs for ultimate consumers, DOJ said.

Insights

Client Alert | 2 min read | 02.03.26

CMS Doubles Down on RADV Audit Changes

On January 27, 2026, the Centers for Medicare and Medicaid Services (CMS) released a Health Plan Management System (HPMS) memo that provided a long-awaited update on how the agency plans to approach previously announced Risk Adjustment Data Validation (RADV) audits for Payment Years (PY) 2020-2024. The memo is the agency’s most comprehensive statement on the subject since September 25, 2025, when the Northern District of Texas vacated the 2023 RADV Final Rule. The memo makes clear that, while CMS has made certain operational adjustments in response to concerns expressed by Medicare Advantage Organizations (MAOs), the agency is largely pressing forward with the accelerated audit strategy announced in May 2025....