The Department of Justice (DOJ) has embarked on an antitrust investigation into a major insurance company, chiefly concentrated on its primary subsidiary and health services division. The probe aims to uncover any anti-competitive practices within the company that could potentially hamper competition in the healthcare industry.
The vast scope of the investigation encompasses the company’s rendering of various health services – pharmacy benefit management, financial consulting, and mental health services. The Bureau has set out to examine all these service segments thoroughly.
This investigative action corresponds with rising concerns over escalating healthcare costs that the American populace has been confronting. In 2022, the average healthcare expenditure per individual was around $13,493.
Investigators are conducting interviews across the various healthcare sectors.
The probe involves investigators conducting interviews across the various healthcare sectors where the company operates, complementing President Biden’s campaign to reduce medication costs. The investigation aims at pharmaceutical practices and their role in hiking up drug prices. Individuals interviewed include clinicians, pharmacists, and insurance providers.
An essential part of the DOJ’s investigation is scrutinizing the company’s Medicare billing procedures to determine whether doctors are unlawfully inflating their patients’ conditions to secure larger government payouts.
The investigation remains active despite the DOJ’s unsuccessful attempt in 2022 to prevent the company from acquiring a healthcare entity. The department seeks to analyze how the company’s acquisition of doctor groups impacts competing businesses and their clients.
Neither the DOJ nor the insurance firm has released any public statements regarding the ongoing investigation. Following receiving a notice regarding a “confidential antitrust probe” from the DOJ last year, the company’s shares dropped by 2.3%, according to Examiner Media. The company has reportedly hired external counsel experienced in complex antitrust cases and pronounced tighter compliance protocols, which slightly recovered its shares. However, the investigation’s ongoing nature continues to cloud its regular operations.
