Sponsors (3)
The bill tightens rules and enforcement to block anticompetitive common ownership between MA plans and providers—protecting competition and directing restitution to harmed communities—but at the cost of potentially disruptive divestitures, reduced MA plan options, increased compliance and legal exposure for providers, and higher administrative costs.
Medicare beneficiaries and patients with chronic conditions are less likely to be steered by vertically integrated Medicare Advantage (MA) ownership because the bill prohibits common ownership of MA plans and providers, helping preserve provider choice and limit price-driven vertical integration.
State attorneys general, HHS OIG, DOJ Antitrust, and the FTC get clearer authority to seek divestiture and injunctive relief against anticompetitive ownership arrangements, strengthening government enforcement against consolidation that harms consumers and taxpayers.
Communities harmed by improper provider revenue can receive a mechanism to return ill-gotten funds to local health care services, directing restitution toward patients and local health systems.
Medicare beneficiaries could face fewer MA plan choices beginning in 2026 if MA organizations lose contracts or are disqualified due to ownership ties, reducing plan options and potentially affecting access and premiums.
Providers and applicable entities face exposure to False Claims Act liability for claims submitted while in violation, risking treble damages and penalties that could threaten provider finances and local access to care.
Owners required to divest within two years may be forced into sales that disrupt care delivery, destabilize hospital systems and MSOs, and raise costs for providers and patients during transitions.
Based on analysis of 2 sections of legislative text.
Prohibits common ownership of Medicare-applicable providers (or their MSOs) and health insurers, requires timed divestitures, and authorizes federal/state enforcement with disgorgement to a community health fund.
Introduced September 17, 2025 by Jeff Merkley · Last progress September 17, 2025
Prohibits any person or entity from simultaneously owning, operating, or controlling a Medicare-applicable health care provider (or a management services organization contracting with such a provider) and a health insurance issuer, and requires one of the entities to be divested within a set deadline (existing common ownership must divest within two years; acquisitions after enactment must divest within one year). It also requires that mergers or ownership reports of these entities be notified to federal antitrust authorities regardless of ordinary filing thresholds. Authorizes civil enforcement by federal agencies (FTC, DOJ Antitrust, HHS Office of Inspector General) and state attorneys general in federal court to seek cease-and-desist and divestiture orders and to disgorge revenues from the violation period. Disgorged funds are to be deposited into an FTC-created fund to address the health-care needs of the harmed community, while preserving private parties' rights to pursue their own legal claims; the bill also directs agency review of the effects of divestitures on competition and financial viability.