Trouble At The Top: Epic Faces Mounting Antitrust Allegations Even As It Grows

Forbes

14-05-2025

Epic Systems is perhaps the most successful health technology company in the world. Its electronic health record (EHR) platform is now used by the majority of large health systems in the U.S. Its customers are vocal in their support and are often passionate defenders of the platform's reliability, configurability, and comprehensiveness. And its commercial success continues: according to newly released KLAS Research data, Epic gained even more market share in 2024, widening the gap between itself and competitors.
Epic won nearly 70% of hospital deals in 2024.
But with that dominance has come increasing scrutiny. Not from regulators yet, but from the companies who say they are being locked out of the future of healthcare innovation.
This week, CureIS Healthcare filed a sweeping lawsuit in federal court accusing Epic of unlawful efforts to block competition. CureIS alleges that Epic has systematically interfered with its business, pressured mutual customers to abandon its products, misappropriated trade secrets, and engaged in false advertising - all in an effort to expand Epic's control over adjacent healthcare IT markets. The complaint paints a picture of a company using its EHR and revenue cycle management hegemony as a springboard to colonize other sectors of the healthcare technology landscape.
And CureIS isn't alone. Particle Health, a startup focused on health data interoperability, filed a separate antitrust lawsuit against Epic last year, similarly alleging that the Verona-based company is using its market power to restrict third-party access to health data and thwart efforts at interoperability that could benefit patients and the broader health system.
Together, the lawsuits suggest that while Epic may be beloved by its customers, its tactics regarding smaller, adjacent vendors may be stirring deeper questions about fair competition and innovation.
CureIS is not a household name, but for more than a decade it has provided software that help Medicaid and Medicare managed care organizations (MCOs) clean up and reconcile enrollment, claims, and billing data - an often messy corner of healthcare IT. These tools, such as EnrollmentCURE and RecoveryCURE, rely on data integrations with technology platforms like Epic's EHR and RCM systems to function effectively.
According to CureIS's complaint, Epic has deliberately prevented those integrations, blocking CureIS from accessing the data its products require. The lawsuit alleges that Epic pressured mutual customers to terminate their contracts with CureIS, sometimes even after those customers had acknowledged that Epic's competing offerings were inferior or incomplete.
Among other issues, the complaint claims that Epic used confidential information shared under non-disclosure agreements to develop its own versions of CureIS products. CureIS says Epic induced customers to share detailed architecture and implementation documents, only to later promise to replicate the functionality internally—often using that very documentation as a roadmap.
More seriously, the lawsuit alleges that Epic imposed an 'Epic-First' policy, in which 'any entity utilizing Epic's EHR or RCM software must use Epic's versions of other products too, if it has a version of the product in question.'
CureIS argues that this conduct not only harmed its own business but also left customers with worse tools and less flexibility, ultimately undermining efficiency and innovation in a sector that already struggles with outdated workflows and fragmented systems.
CureIS's complaint echoes themes raised earlier this year by Particle Health, which similarly claims that Epic's business practices are impeding fair access to patient data and suppressing interoperability. Particle's focus is on the 'last mile' of health data—getting information from disparate systems to where it's needed most. The company argues that Epic's control over the nation's health records gives it undue influence over what data is shared, how it's shared, and who can participate in that exchange.
The core concern in both suits is not just Epic's size, but how that size and market power is allegedly being used. In both cases, plaintiffs argue that Epic is no longer simply competing on the merits of its core products, but actively leveraging its power to prevent others from doing so.
This dynamic would be easier to dismiss if Epic's platform weren't, by most accounts, genuinely effective. The company is trusted by its users in a way that few software platforms are. It routinely scores top marks for customer satisfaction. It delivers deeply integrated functionality. And for hospital IT departments besieged with too many vendors that don't deliver, Epic has become a true partner.
That customer devotion has helped fuel a virtuous cycle. Epic is now expanding beyond EHR and RCM into a broad suite of tools that serve payers, pharmaceutical companies, laboratories and even consumers. By doing so, it is building out network effects that reinforce its central role in the healthcare ecosystem, connecting stakeholders who all increasingly rely on Epic's infrastructure to operate, communicate, and exchange data.
From its Cosmos data platform, which aggregates clinical data for research, to its health plan integration features, Epic is creating a flywheel where each new product reinforces demand for others. But that same flywheel, in the eyes of its critics, can look like a walled garden—one where innovation flows only from the center, and others must knock (or sue) to get in.
The lawsuit comes against a broader regulatory and legal backdrop that is increasingly skeptical of dominant tech platforms, and how they might be leveraging their power.
CureIS explicitly cites Epic's alleged information blocking as a violation of the 21st Century Cures Act and the associated federal regulations implemented by the Office of the National Coordinator for Health IT. These rules prohibit "actors"—including health IT developers—from interfering with the access, exchange, or use of electronic health information. The complaint accuses Epic of exactly that: denying CureIS and mutual customers the data access necessary for CureIS's software to function, despite customer authorization, and without any valid exception under the rule. In a post-Cures Act environment, such conduct isn't just anticompetitive—it may be illegal under federal information blocking provisions.
Outside of healthcare, courts are increasingly drawing hard lines around similar forms of platform dominance. In a major ruling last year, Judge Amit Mehta found that Google's $20 billion in annual payments to Apple to remain Safari's default search engine constituted illegal anticompetitive behavior.
More recently, the U.S. Department of Justice signaled it is seeking structural remedies that could force a breakup between Google's Chrome browser and its search advertising business. Apple, too, has drawn judicial ire: despite a prior court order requiring it to loosen App Store restrictions that prevent developers from steering users to alternate payment options, a federal judge recently found that Apple continues to flout the order, delaying compliance in ways that sustain its control over app monetization. Together, these cases underscore a growing legal recognition that platform power, when abused to entrench incumbency and exclude competition, is not only harmful but actionable.
"Epic believes in free and fair competition, and we also believe our customers are in the best position to choose the right solutions to meet their needs—whether with Epic or by adopting other products and services," an Epic spokesperson said in a request for comment.
After two lawsuits alleging unlawful tactics that implicate antitrust concerns, however, the pattern is increasingly difficult to ignore.
The company declined to answer specific questions about the case, including whether an 'Epic-First' policy exists.
As Epic pushes further into adjacent markets including telehealth, CRM, prior authorization, and more, vendors and investors alike are watching closely. If the company is truly replicating third-party functionality and using integration as a chokepoint, or representing 'vaporware' as a reason to avoid competitors, it raises fundamental questions about the rules of the road in digital health.
These questions are especially urgent in light of Epic's market trajectory. Epic continues to win the majority of hospital deals and gain even more ground, especially among large hospitals and health systems. With nearly universal adoption among top-tier academic centers and continued wins among regional health systems, Epic's position is not just dominant—it's bordering on infrastructural.
That kind of power brings responsibility not just to customers, but to the broader healthcare innovation ecosystem. Epic's platform is central to how care is delivered, how value is measured, and how data flows. Whether it is also central to how innovation happens—or whether it is increasingly a bottleneck—is now a question for courts, policymakers, and the market to weigh.
Epic's size and success could make it a gravitational center that lifts up the innovation ecosystem around it. But if its conduct instead undermines startups that offer real value - especially in underserved areas like Medicaid managed care - then lawsuits like CureIS's may be just the beginning.
Healthcare needs platform players that enable innovation, not just defend territory. Epic may be at a crossroads: the company's core EHR product is the reason it continues to gain market share, yet its insistence on leveraging that EHR to advance its growth efforts may bring the type of scrutiny and lawsuits that threaten that success.