The Supreme Court on Monday refused to review the lower court’s decision that Atrium Health is not affected by antitrust litigation due to its status as a “local government unit.”

The judge refused petition Reinstatement of the proposed class action, allegations Courtyard Take advantage of its dominant market position Stop insurance company Shift from guiding patients to cheaper health care options.

A patient of Atrium Health originally sued the Charlotte-Mecklenburg Hospital Authority (Atrium’s business entity) in 2018. A federal court in North Carolina and the U.S. Court of Appeals for the Fourth Circuit both ruled against the patient. The Fourth Circuit stated in April that although the multi-state public hospital system continues to grow significantly, it is still designated as a department of the local government and is therefore protected by antitrust litigation.

The Court of Appeal stated that it is up to the legislator, not the court, to determine Atrium Health’s designation because it involves major policy considerations.

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The patient appealed to the Supreme Court in August, claiming that Atrium had exceeded its original “local” classification. The appeal claims that the antitrust exemption law is designed to cover institutional units that have power over small geographic areas, rather than a multibillion-dollar hospital system operating in multiple states.

Atrium formally opposed the appeal in October, telling the judge that the North Carolina High Court said it was eligible as a local government entity.