Federal Antitrust Litigation Seeks to Hold MultiPlan, Major Insurance Companies Responsible for Alleged Coordinated Price-Fixing Scheme
Leading to Under-Reimbursement for Out-of-Network Services
The Texas Medical Association (TMA) has joined a federal multidistrict litigation against MultiPlan (recently rebranded to Claritev) and major insurers, including UnitedHealth, Elevance, Humana, Aetna, and Cigna, alleging they conspired to systematically underpay health care practitioners for reimbursements for out-of-network services, which often fail to even cover operating costs. MultiPlan goes by many names, including Data iSight, Viant, NCN, ProPricer, and MARS. Plaintiffs allege that MultiPlan facilitated a price-fixing agreement among insurers that artificially suppressed out-of-network payment rates and cost physicians and providers billions of dollars.
TMA joins the American Medical Association (AMA) and hundreds of physician practices and facilities nationwide in this growing antitrust litigation.
“For many years, physicians in Texas have been forced to accept increasingly insufficient reimbursements for providing health care to out-of-network patients,” said TMA President Jayesh “Jay” Shah, MD. “This lawsuit is an important step to ensure that physicians are justly reimbursed for the care they provide, not only today, but also for historical underpayments going back to at least 2015, and end this alleged illegal collusion that hurts patients.”
This lawsuit, filed in the Northern District Court of Illinois in 2024, seeks to end MultiPlan’s alleged anticompetitive scheme that it has operated since at least 2015, and recoup financial damages for practitioners and practices. As of 2024, MultiPlan processes more than 80% of all commercial out-of-network reimbursement claims in the United States. Physicians and providers may not always know whether MultiPlan, or one of its services like Data iSight, Viant, NCN, ProPricer, or MARS, re-priced their claims. Clues can often be found in Explanations of Benefits or remittance advice.
Physicians who believe they have been harmed by MultiPlan and the insurance companies, whether current or in past years, can obtain a free case evaluation from one of the attorneys appointed by the court to lead the non-class claims.
The court also has appointed attorneys to litigate a proposed antitrust class action on the same issues, but a ruling on any proposed class certification is not expected until 2027. Physicians and providers who believe they have been impacted by MultiPlan’s conduct can choose to pursue their claims individually on a non-class basis and do not need to wait for any ruling on a proposed class.