Patients Over Profits Act Targets Vertical Integration in U.S. Healthcare Market

The Patients Over Profits Act, introduced by a bipartisan group of U.S. Senators and Representatives, seeks to prohibit the ownership of both health plans and healthcare provider organizations that accept Medicare Part B or Medicare Advantage payments.

The legislation is aimed at dismantling payer-provider conglomerates, often referred to as payviders, to address concerns about market consolidation and vertical integration in the healthcare industry. While the bill allows exceptions for certain types of providers such as hospitals and durable medical equipment businesses, it targets companies like UnitedHealth Group, which have significant integrated operations across payer and provider services. The bill would empower federal agencies including the Federal Trade Commission and the Department of Justice to enforce divestitures and recover revenues if companies fail to comply within specified timeframes.