DOJ v. OhioHealth Confirms Antitrust Enforcers’ Continued Focus on Health Care Markets

On February 20, 2026, the Department of Justice’s Antitrust Division (DOJ) and Ohio Attorney General (Ohio AG) sued OhioHealth Corporation (OhioHealth), alleging that OhioHealth had unlawfully restrained trade in the market for general acute care inpatient hospital services in the Columbus metropolitan statistical area and the narrower Central Columbus area, respectively. The DOJ and Ohio AG allege violations of Section 1 of the Sherman Act, as well as the Valentine Act (Ohio’s antitrust statute), claiming that OhioHealth leveraged its market power to impose contractual restrictions that blocked payors from working with competing health systems to design “budget-conscious” lower-cost health plans.

In announcing the lawsuit, Attorney General Pam Bondi stated that “Americans deserve low-cost, high-quality healthcare – not anticompetitive hospital system contracts that make healthcare less affordable,” and that the DOJ “will continue taking legal action to protect consumer and drive down healthcare costs across America.”

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DOJ v. OhioHealth: Allegations and Claims

The DOJ and Ohio AG allege that OhioHealth is a dominant or near-dominant system that has used its size to restrict price competition, prevent competing systems from gaining scale, and raise entry barriers.

Relevant Market and Market Power

Beginning with product market, the case focuses on the market for inpatient general acute care services (GAC services), which is the traditional market definition in hospital merger cases or cases challenging conduct by a dominant hospital system. Geographically, the DOJ and Ohio AG are focused on two markets: the ten-county Columbus metropolitan statistical area; and (ii) the narrower “Central Columbus” sub-market, which consists of just Franklin and Delaware counties. In alleging the narrower “Central Columbus” market, the DOJ and Ohio AG rely on a November 2024 market share update from OhioHealth, as well as the fact that six OhioHealth hospitals, including its flagship, are in those two counties.

As for evidence of OhioHealth’s market power, the DOJ and Ohio AG point to:

• • Market shares greater than 35% (based on both inpatient discharges and inpatient bed capacity for GAC services).
  • OhioHealth’s scale and facility footprint.
  • OhioHealth’s ability to charge higher rates for lower-quality care than its competing health systems based on Leapfrog and CMS ratings.

The DOJ and Ohio AG also focus on OhioHealth’s practice of grouping its facilities together during negotiations with a take-it-or-leave-it approach. According to the DOJ and Ohio AG, this approach is effective because OhioHealth owns multiple hospitals, particularly in Columbus and other rural areas in the state, that payors must include in their networks to be commercially viable for their customers. The DOJ and Ohio AG also allege that payors have attempted to push back against the at-issue provisions, but OhioHealth “summarily refused.”

Conduct and Effects

With respect to the challenged conduct, the DOJ and Ohio AG allege that OhioHealth leveraged its power to prevent payors from working with competing health care providers to offer “budget-conscious” health plans. Specifically, OhioHealth allegedly forces payors to include OhioHealth in every network for commercial insurance products, regardless of how OhioHealth’s prices compare to its competitors’, and requires that OhioHealth be featured at the most favored level of benefits in each of the payors’ networks. Thus, according to the DOJ and Ohio AG, OhioHealth’s contractual terms block payors from creating narrow or tiered network plans or otherwise using steering strategies or reference-based pricing to create “budget-conscious” plan designs. The DOJ and Ohio AG further allege that the restrictions reduce transparency, referring to the restraints as “gag rules” that prevent dissemination of pricing information.

In terms of impact, the DOJ and Ohio AG allege that the effect of these restrictions is pervasive, claiming that the restrictions apply to payors that collectively account for at least 85% of the commercial health insurance business in the Columbus area.

Participants in health care markets should watch the case as it progresses, including whether OhioHealth moves to dismiss the actions on the pleadings and whether any private plaintiffs follow the DOJ’s lead in challenging the alleged conduct.