Justice department opens investigation into NewYork-Presbyterian – Becker’s Hospital Review | Healthcare News
The Justice Department has launched a civil antitrust investigation into New York City-based NewYork-Presbyterian regarding concerns over health insurer contracts that could have raised healthcare costs and lessened competition, The New York Times reported July 28.
The subpoena, obtained by The New York Times, probes whether NewYork-Presbyterian used insurer contractual agreements to prevent lower-cost hospital competition, which would allow the system to charge more for routine medical procedure prices without the fear of losing patients.
The investigation was prompted by a 28-page complaint filed by Local 32BJ of the Service Employees International Union in 2024. The union, which represents around 90,000 New York City workers, claims that NewYork-Presbyterian repeatedly obstructed efforts to direct patients to more cost-friendly providers, leaning on restrictive insurance agreements that kept the union’s health fund from excluding the system from its network or increasing copays.
The union cited billing data that alleges NewYork-Presbyterian procedures are significantly more costly than other hospitals, including hip replacements that averaged $83,000 at NewYork-Presbyterian for the health fun, versus $58,000 elsewhere. It also pointed to colonoscopies costing twice as much at NewYork-Presbyterian versus other locations.
Third-party administrators, including Aetna, were willing to create a network that excluded NewYork-Presbyterian. However, the hospital told Aetna that the union health fund owed $25 million in unpaid medical bills, which the union contended was retaliatory. The union and Anthem eventually partnered to develop a network that excluded NewYork-Presbyterian.
“Our union is committed to providing affordable, high-quality healthcare for its members, and if that takes us into a fight at the bargaining table, the policy debate or for city and state legislation, we will be there,” Manny Pastreich, SEIU 32BJ President, said in a July 28 statement shared with Becker’s. “We will not let hard-working New Yorkers be taken advantage or bear the brunt of unfair price hikes and we will hold big hospital chains like New York-Presbyterian accountable for its anticompetitive practices.”
The Justice Department declined Becker’s request for comment. Becker’s has also reached out to NewYork-Presbyterian for comment and will update this story should more information become available.