A federal district judge has denied motions to dismiss antitrust and consumer protection claims against MultiPlan and payer codefendants, allowing litigation brought by healthcare providers alleging collusion to proceed.
The decision from Judge Matthew Kennelly of the U.S. District Court for the Northern District of Illinois Eastern Division encompasses two consolidated complaints against the data analytics company, which recently rebranded as Claritev.
One of the complaints, a class action, lists MultiPlan, insurers and managed care organizations as codefendants, while a second direct action complaint also includes allegations against third-party administrators.
Both complaints involve a platform offered by the company that calculates out-of-network rates for providers and a service in which MultiPlan would negotiate that rate with providers on behalf of the payer in exchange for a fee. Plaintiff providers have criticized each of those services.
In their lawsuits, providers likened the agreements with codefendant insurers such as UnitedHealth Group, Elevance Health, Aetna and Cigna to a collusive “cartel,” arguing that they share confidential information to suppress rates. Claritev has countered that its reimbursement recommendation product uses common, publicly available data sources, not competitor data, when making its recommendations to managed care organizations and third-party administrators.
On the provider rate negotiations, the defendants have said that providers do not need to accept the rate and can seek payment directly from the patients or their insurer. Plaintiffs have argued that those negotiation services unduly pressure physicians into accepting low payment offers, which then lock them out of pursuing further balance payments from insurers.
Plaintiffs, in their complaints, have said that the arrangements have driven about $19 billion of underpayments in 2020 and $6.4 billion of underpayments during the third quarter of 2024 alone. Doing so “has forced many medical practices, particularly smaller ones, to shut their doors, cease offering certain services, or seek other employment arrangements, leaving patients with fewer and fewer medical practice options,” the American Medical Association (AMA), one of the plaintiffs, said in October when filing its suit.
Claritev and its business partners filed for the dismissals in January, with both sides arguing their case in hearings. Though they persuaded the judge to toss plaintiffs’ claims of unjust enrichment, the judge found other arguments to be plausible and so denied motions to dismiss federal and state antitrust claims as well as state consumer protection claims.
AMA President Bruce Scott, M.D., in a Tuesday statement, celebrated the procedural victory as “the clearest statement yet by a court” that the company’s conduct appears to be an antitrust violation.
“MultiPlan and the commercial health insurance companies have profited from the rigged system, while forcing physicians to accept lower and lower payment amounts for out-of-network services—payments that in many cases do not cover the cost of delivering care to patients,” Scott said. “Ending this conspiracy is a good start toward creating an open and honest system that will restore fair reimbursements and help ensure patients have access to the care they need.”
“MultiPlan has long claimed its mission is to bend the healthcare cost curve for all,” added plaintiffs’ counsel heading the direct action litigation in a separate statement. “For too long, it has bent that curve in the favor of payers, systematically under-reimbursing providers. The Court’s ruling allows our case to proceed as we take discovery and challenge these practices on behalf of our clients.”
Claritev, in a statement, said it is confident in its legal position and ready to “vigorously defend ourselves” as the case proceeds.
“Claritev has always upheld the highest standards of integrity and transparency, operating in full compliance with all applicable laws and regulations,” the company said. “We remain confident that the facts will reinforce what we’ve consistently said—that these lawsuits are without merit and fail to acknowledge the critical role our competitive options play in reducing healthcare costs for employers and improving access for patients. These lawsuits will only serve to increase healthcare cost for employers and patients.”