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The FTC issued an administrative complaint and authorized a federal court action to block Sanford Health's proposed acquisition of Mid Dakota Clinic, alleging that the deal would vioated antitrust law by significantly reducing competition for adult primary care physician services, pediatric services, obstetrics and gynecology services, and general surgery physician services in the greater Bismarck and Mandan metropolitan area. The FTC, jointly with the Office of the Attorney General of North Dakota, filed a complaint in federal district court seeking a temporary restraining order and preliminary injunction to stop the deal and maintain the status quo pending an administrative trial on the merits. According to the complaint, Sanford and Mid Dakota are each other's closest rivals in the four-county Bismarck-Mandan region of North Dakota, and the merger would create a group of physicians with at least 75 to 85 percent share in the provision of adult primary care physician services, pediatric services, obstetrics and gynecology services. On July 9, 2019, after Sanford abandoned its acquisition of Mid Dakota Clinic, the Commission announced that it voted 5-0 to dismiss the case.