Hello, all you Relentless Tribe members. This is the third episode in our legal goings-on trifecta, starting with Doug Aldeen in episode 512 covering what amounts to the main reasons plan sponsors wind up suing their brokers or employee benefit consultants.
For a full transcript of this episode, click here.
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In our last episode (this was last week), that one was very, very much a prelude to this episode this week with Matt Cantor. I'm talking about episode 513 with Brennan Bilberry, where we broke down the cunning anticompetitive contracts that many consolidated health systems may choose to use to lock up local geographies.
And that local part is really important. Do not underestimate it, because healthcare is local, as we have heard so many times on the show. And that knowledge that healthcare is local can be used as an opportunity for patient-first endeavors, for sure; but it also can be used as a lever to maximize profits.
So, with Brennan last week—and if you didn't listen, do go back after this show and take a listen would be my recommendation—but last week, Brennan and I talked about the all-or-nothing clauses and the anti-steering and anti-tiering provisions that prevent plan sponsors from guiding their members to higher-quality, low-cost care.
And if you're thinking about all-or-nothing and anti-steering, anti-tiering, anticompetitive contracts, you might be remembering the episode with Cora Opsahl (EP452), where she gets into somehow the 32BJ union was subject to an anticompetitive contract that they didn't sign. 32BJ, the union that Cora worked for at the time, had to fight to give a low-cost maternity option to their members. And while they succeeded, most plans (let's get real) probably would not have.
It is insane if you think about it (and do go back and listen to that show) the amount of power some random hospital in the area wielded over a union who wanted nothing to do with them.
I say all this to say that today we are looking at what happens when someone finally says enough is enough and drags the 800-pound health system gorilla into court to answer for these exact types of contracting practices.
Before we start, though, quick level set: As has been demonstrated quite crisply and probably almost every single Relentless Health Value episode, the healthcare sector is, in so many ways, just one big market failure. One local market at a time in this country.
The point being, when health plan premiums skyrocket, everyone's first instinct is to blame the carrier. And fair enough, right? They're up to their own FTC and DOJ violations.
But also 80% to 85% of premiums are directly made up of underlying medical costs, and usually about 50% of those underlying medical costs are hospital charges. They are a plan paying for members who have visited a health system, and those hospital and health system prices are being driven up, in fact, by the corporate interests of these giant hospital systems operating in local geographies where they face little or no competition and/or pricing pressure.
It's just so sad when the leadership of these esteemed entities loses themselves at the level which some have. And, by the way, for a real deep dive on what I just said, go back and listen to the episode with Vivian Ho, PhD (EP466).
But yet holding these large, consolidated corporatized health systems accountable is incredibly difficult for many reasons; but a really, really big one is the halo effect. As Matt Cantor, my guest today, again points out, doctors and nurses and others who work at hospitals save lives.
Now there is a reason why, as Komal Bajaj, MD, said in the episode with her (EP458), there is a reason why almost half of those who work at a hospital don't trust their leadership to do right by themselves or by patients.
But when you go to court, it is very, very hard for a judge or a jury to separate the amazing doctors and nurses working on the floor from the corporate administration up in the C-suite that is utilizing market power to extract maximum revenue from a local community and often doing it tax-free.
Speaking of tax-free, add to all of this the fact that the FTC does not have jurisdiction over "nonprofits," and your primary witnesses—here's another problem—your primary witnesses usually against the hospitals are often, I dare say, extremely unsympathetic insurance executives or former executives, right? There is a steep uphill battle by almost any estimation.
But today, we talk about how that needle was threaded.
My guest today, Matthew Cantor, is an antitrust lawyer who was the lead trial and appellate counselor for the class in the landmark antitrust case against the Sutter Health System in Northern California.
After 13 years of litigation, three trips to the Ninth Circuit Court of Appeals, and right before the opening statements in a retrial, Matt and his team secured a $228.5 million settlement.
Why does this matter so much to self-insured employers and plan sponsors? Because this case established a groundbreaking precedent. Matt's team proved that the indirect purchasers, meaning everyday people and also the employers actually paying the inflated premiums, these indirect purchasers can recover damages from these hospital overcharges.
This is a new frontier. The DOJ is already picking up what this case put down, pursuing similar anti-steering litigation against health systems like Ohio Health and NewYork-Presbyterian. But the real opportunity may lie, as it often does, with self-insured employers. We've been saying this for years, but yeah … here we are.
There is so much latent potential here, which is also called the Sleeping Giant of self-insured employers. Which I will be talking about later on with Suhas Gondi, MD, MBA, when he makes a return appearance on the show in a month or so.
But yeah, if any self-insured employer is tired of being a passive price taker, which is the term used by Patrick Nelli in episode 509, this episode shows that litigation and/or maybe, I don't know, the threat of litigation is a viable possibility to keep providers with market power in check.
This episode is packed with so many aha moments, just … yeah, you're gonna love it.
But before we get there, I do need to thank some amazing folks who help keep this show on the air by providing some financial support, even though some of us over here are not getting paid, it is crazy how all of the out-of-pocket expenses add up.
So, I am very thankful, and maybe you are, too, if you listen to the show on the regular. I am very thankful to, first of all, Kimberly Carleson. Kimberly has covered our costs for our podcast editing software for the entire year in 2026. Thank you so much, Kimberly Carleson.
Wanna thank also Marilyn Bartlett. Marilyn has been a longtime supporter of Relentless Health Value, and she has been covering the cost for Adobe Creative Suite licenses for 2026 for our team, which we use for design and episode mixing. Thank you so much to Marilyn Bartlett.
Next, I'd like to thank Matt McQuide. Matt's contribution monthly has been covering the hosting and distribution of our podcast episodes. Thank you so much, Matt McQuide.
Next, let me thank Dr. Vivian Ho. Dr. Ho has contributed to cover the 2026 costs for our newsletter provider. Thank you so much.
Also on my list here to thank is Doug Geinzer. Doug paid for our audio engineer for a full month. Thank you so much to Doug Geinzer.
And then lastly, we have the trio Scott Conard, MD; Mike Tuggy, MD, FAAFP; and Larry Bauer, MSW, MEd. One of our newest recurring contributions is also helping to cover the cost of our audio engineer on a monthly basis.
Thank you so much to these individuals who help keep our show on the air. We'll have some more that I am looking forward to thanking next week.
This podcast is also sponsored by Aventria Health Group, who is our founding underwriter.
Also mentioned in this episode are Doug Aldeen; Brennan Bilberry; Cora Opsahl; 32BJ; Payerset; Vivian Ho, PhD; Komal Bajaj, MD; Suhas Gondi, MD, MBA; Patrick Nelli; Kimberly Carleson; Aventria Health Group; Shinder Cantor Lerner LLP; Monica Lypson, MD, MHPE; Daron Pitts; Thomas Frangione; Ivana Krajcinovic, PhD; and Elizabeth Mitchell.
For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here.
You can learn more at scl-llp.com and by following Matt on LinkedIn.
Matthew Cantor, JD, is a founding partner of Shinder Cantor Lerner LLP, an antitrust law firm that specializes in healthcare matters, based in New York and Washington, DC. Matt has over 30 years of experience litigating substantial, multibillion-dollar antitrust litigations. He has led a number of trial teams and argued multiple times in the appellate courts. He was lead trial and appellate counsel for the Certified Class of employers and individuals in Sidibe v. Sutter Health, an antitrust case that concerns claims that Sutter imposed anti-steering clauses and all-or-nothing contracting on health plans that resulted in Class members paying higher health insurance premiums. The Sutter Health case resulted in a $228.5 million settlement for the Class. Matt has a JD from the New York University School of Law and a BA from the University of Michigan.
00:00 Introduction to this episode.
04:26 Why does the halo effect make it difficult to hold hospitals accountable?
04:46 EP458 with Komal Bajaj, MD.
06:16 Why the case around this episode matters.
09:31 The conversation with Matt Cantor.
09:36 The brief background of how we got here.
10:55 The Sutter litigation: an overview.
12:57 Local geography versus local market.
14:51 EP466 with Vivian Ho, PhD.
17:50 Why litigation?
18:00 EP513 with Brennan Bilberry.
23:50 Why are these cases so difficult?
26:08 LinkedIn post by Kimberly Carleson on the Blue Cross Blue Shield settlement.
26:13 Comment by Daron Pitts on Kimberly Carleson's LinkedIn post.
26:32 Comment by Thomas Frangione on Kimberly Carleson's LinkedIn post.
27:36 What Matt Cantor thinks will be the future of litigation against these hospital systems.
28:11 Why Sutter?
31:21 What led to the ultimate victory in the Sutter case.
33:05 EP501 with Ivana Krajcinovic, PhD.
35:42 EP436 and EP491 with Elizabeth Mitchell.
37:35 EP509 with Patrick Nelli.
37:52 What is possible for employers now?
40:54 Antitrust enforcers that employers should consider.
41:49 The greatest challenge in fighting healthcare costs and medical spend.
Recent past interviews:
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Brennan Bilberry, Doug Aldeen, Dr Siva and Dr Monica Lypson, Betsy Seals, Patrick Nelli, Lee Lewis, Stacey Richter with 15 experts (EP507), Jerry DiMaso