Sutter Health is scheduled to go to trial in October in a lesser-known antitrust case which is based on allegations that are remarkably similar to those the health system paid US$575 million to settle in 2019, reported Modern Healthcare.
The case, Sidibe v. Sutter Health, was filed a few years before its closely-watched cousin, UFCW & Employers Benefit Trust v. Sutter Health, which took the spotlight when California’s Attorney General joined in 2018. Both lawsuits accuse the Sacramento, Calif.-based healthcare giant of imposing all-or-nothing contracts that have forced people to overpay by hundreds of millions of dollars over the years. That is, with a key difference: While the UFCW case centers on harm to self-insured plans, Sidibe concerns fully insured plans.
The contrast adds a layer of complexity that could make the case harder for the Sidibe plaintiffs to win. It’s easier to prove harm to employers with self-insured plans, since they pay medical bills themselves and accept the risk of covering members’ healthcare costs, which means they’re directly affected by Sutter’s alleged conduct. Proving harm to fully insured plans—employers that buy plans from insurance carriers—requires the extra step of proving those insurers passed on the higher costs to premium payers.
“It just seems like that’s going to be a bit of a challenge to prove,” said Bill Horton, a partner with Jones Walker and co-chair of its healthcare industry team, who is not involved in the case.
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