Health Insurers Under Fire: New Administration Cracks Down on Evasive Pricing Practices

Health insurance regulations are rapidly shifting with unprecedented intensity. Amid growing public outrage over evasive and abusive pricing practices by insurers and years of federal underenforcement, the new administration has sent a clear message to health insurers: transparency in pricing is now mandatory.

Following the foundational 2019 executive order¹ issued by the first Trump administration, federal regulators finalized the Transparency in Coverage (“TiC”) Final Rule² in October 2020 — an initiative designed to help consumers make more informed healthcare decisions through the public disclosure of accurate and understandable pricing data by insurers.³ The U.S. Departments of Health and Human Services, Labor, and Treasury jointly issued the rule, promising a new era of pricing transparency and accountability.

But more than four years later, that promise remains largely unmet.

How Insurers Undermine Transparency

Instead of real transparency, many insurers have opted for technical compliance and practical obstruction. Required pricing data files are often bloated, disorganized, and riddled with duplicative or irrelevant information. The formats are so complex or poorly labeled that even professional analysts struggle to interpret them. For the average consumer, the files are functionally indecipherable. What was intended to empower patients in making healthcare decisions instead delivers digital noise — a compliance façade by insurers dressed up as reform, with no meaningful benefits to consumers.⁴

In early 2023, Sens. Margaret Wood Hassan and Mike Braun sounded the alarm in a letter to the Centers for Medicare & Medicaid Services (CMS), calling for stronger administrative oversight and government action to ensure that insurers comply not just in form, but in substance to the intent behind the TiC Rule.⁵ Yet, insurers are still not held accountable when they fail to post pricing data or post data that is incomplete, unusable, or misleading. That is unacceptable.

A New Mandate: Executive Order 14221

Now, the new administration is signaling it’s had enough.

On February 25, 2025, President Trump issued Executive Order 14221 titled “Making America Healthy Again by Empowering Patients With Clear, Accurate, and Actionable Healthcare Pricing Information,”⁶ directing federal agencies to crack down on evasive insurance pricing practices and reinvigorate enforcement of the TiC Rule. Agencies were mandated to take the following actions by May 25, 2025:

1. Require insurers to publicly disclose actual prices for healthcare services — not estimates.
2. Issue updated guidance and regulatory action to ensure pricing data is standardized and easily comparable across health plans.
3. Update enforcement policies to ensure full compliance with the transparency rules — mandating that pricing disclosures be complete, accurate, and meaningful to consumers.

For insurers, the message is clear: the era of vague estimates, unreadable files, and strategic opacity on pricing is over. Noncompliance will no longer be met with silence. Legal consequences and reputational damage are now real and on the table.

Enforcement Beyond CMS: DOJ Enters the Fray

Whether Congress chooses to reinforce these efforts through legislation remains uncertain. But early moves by the administration suggest serious follow-through on matters related to insurer pricing. Notably, the Department of Justice (“DOJ”) has intensified its antitrust scrutiny of pricing practices across the insurance industry. In In re MultiPlan Health Insurance Provider Litigation, the DOJ recently filed a Statement of Interest[7] asserting that insurers — including UnitedHealthcare, Anthem (Elevance), and Cigna — can be held liable under Section 1 of the Sherman Act for using shared pricing algorithms to coordinate pricing. The DOJ clarified that price collusion may occur even without direct communication, so long as competitors rely on a common algorithm or intermediary to set pricing strategies. This theory of indirect coordination may soon become an additional tool critical to federal enforcement efforts thwarting abusive pricing practices by health insurers.

Transparency Is the New Battleground

For health insurers, the days of buried data, inaccessible disclosures, hidden deals with competitors, and hollow compliance with the TiC Rule are coming to an end. Transparency in pricing must be treated not as a regulatory nuisance, but as a legal imperative. The administration isn’t just shining a spotlight on the insurance industry — it’s aiming that spotlight with political resolve and federal enforcement teeth.

Insurers that continue to treat pricing transparency as a box-checking exercise risk more than just being left behind — they risk finding themselves in the crosshairs of a government determined to expose and end evasive and abusive pricing practices.

For more information about health insurers’ abusive and evasive pricing practices — and insight into actionable steps to stop them — please contact AGG Healthcare partners Rich Collins and Damon Eisenbrey and associate Kelley Chandler. Rich and Damon are recognized leaders in matters involving health insurers’ financial conflicts of interest in adjudicating and pricing healthcare claims. They are deeply committed to advancing transparency, accountability, and proper reporting by insurers on behalf of insureds, plan members, and healthcare providers.

[1] Executive Order 13877, Improving Price and Quality Transparency in American Healthcare To Put Patients First (June 24, 2019), available here. 

[2] See 45 C.F.R. § 147.212, Transparency in Coverage Final Rule, available here; see also, Centers for Medicare & Medicaid Services, Transparency in Coverage Final Rule Fact Sheet (CMS-9915-F), available here.

[3] The TiC Rule requires that non-grandfathered group health plans and health insurers make disclosures both (1) publicly in machine-readable file format related to in-network provider rates for covered services and out-of-network allowed amounts and billed charges for covered services; and (2) to participants and beneficiaries through an internet-based self-service search tool or in paper form upon request. See 45 C.F.R. §§ 147.211, 147.212.

[4] See Transparency in Coverage: Recommendations* for Improving Access to and Usability of Health Plan Price Data, Georgetown Center on Health Insurance Reforms, available here.

[5] Letter to CMS Administrator Chiquita Brooks-LaSure, Senator Margaret Wood Hassan & Senator Mike Braun (March 6, 2023), available here.

[6] Executive Order 14221, Making America Healthy Again by Empowering Patients With Clear, Accurate, and Actionable Healthcare Pricing Information (Feb. 25, 2025), available here.

[7] See Statement of Interest of the United States, Dkt. No. 382, filed March 27, 2025, In Re Multiplan Health Insurance Provider Litigation, Case No. 1:24-cv-06795 (N.D. Illinois 2024), available here.