MultiPlan antitrust litigation gains momentum after rulings for providers

Healthcare providers obtained two favorable rulings over the last month in their massive antitrust litigation against a vendor’s repricing algorithm.

The case entails allegations that MultiPlan — which since has rebranded as Claritev — conspired to set out-of-network (OON) payment rates by gathering competitively sensitive information from roughly 700 health plans and using that information in a proprietary pricing algorithm.

Those rates were then available to be implemented by participating insurers, which are co-defendants in the case, as are third-party administrators. Providers argued they had little practical ability to do anything but accept the rates generated by MultiPlan, which receives a fee based on the savings relative to the originally billed charge.

The arrangement suppressed payment rates over roughly a decade, allege the provider-plaintiffs, who have said MultiPlan processed claims worth more than 80% of all commercial OON reimbursement in 2019. Plaintiffs are seeking damages they say could exceed $100 billion even before statutory trebling.

The multidistrict litigation (MDL) has both a class-action track and hundreds of cases filed by individual plaintiffs. Over the last month, the federal judge overseeing the MDL ruled for providers in two instances that could give them an edge as the litigation proceeds.

MultiPlan has said its repricing services do not constitute an illegal conspiracy. The payment rates determined by the algorithm are simply recommendations, the company has noted.

Court rejects defenses aimed at limiting provider recovery

One of MultiPlan’s initial defenses in the case was that providers lacked antitrust standing because any injury from reduced insurer payments was indirect.

“OON providers like Plaintiffs are not injured by allegedly suppressed OON reimbursements where, as here, they can bill their patients for unpaid amounts,” the company stated in an April 2025 court filing.

“The proximate cause of any injury to the provider arises from the patient’s decision not to pay, not any alleged conspiracy,” the filing states.

In June 2025, those arguments fell short of persuading Judge Matthew Kennelly (a Clinton appointee) of the U.S. District Court for Northern Illinois to dismiss the core antitrust claims.

MultiPlan and the insurers more recently sought to raise mitigating arguments that could apply even if the plaintiffs’ claims are determined to be true. One such argument was an “unclean hands” defense, asserting that improper provider billing practices should bar or limit recovery even if plaintiffs prove their core claims.  

The argument focused on “all the typical payer-provider reimbursement dispute stuff that you see in audits and everything else,” said Matt Lavin, a partner at Gilbert LLP and a member of the executive committee coordinating the litigation on behalf of hundreds of plaintiffs.

Kennelly denied that argument by the defendants, saying even if providers’ hands were unclean, horizontal price fixing should not be a permissible remedy.

The message from that ruling is that regardless of provider conduct, “it’s about the payers [having] complete control over how they were pricing the reimbursements,” Lavin said.

Bellwether cases move toward discovery and trial

There are 36 bellwether cases proceeding to trial, with depositions set to begin in upcoming months and trial dates projected for early 2028.

Those cases are intended to test claims involving a cross-section of providers participating in the MDL. The bellwether plaintiffs range from large health systems to stand-alone physician practices.

In the second noteworthy ruling over the last month, the court said during a June 26 case-management conference that 17 insurers (including companies affiliated with Aetna, Blue Cross Blue Shield plans, Cigna and UnitedHealthcare) are eligible to be added as defendants by bellwether plaintiffs that initially sued only MultiPlan.

The push to incorporate additional defendants stemmed from ongoing discovery in the case, including an effort by the plaintiffs to review phone records and text messages that could show the frequency and timing of contacts among MultiPlan and the insurers.

“Regardless of whether the actual content of phone calls or text messages is available, the cell phone records themselves can provide crucial circumstantial evidence corroborating the existence of a conspiracy by showing the sheer number of contacts between competitors,” plaintiffs stated in a March court filing.

Recent rulings strengthen providers’ position

As the MDL continues, the recent rulings can be seen as good signs for providers.

“Plaintiffs are in a very strong position right now, and I think it’s a terrific time for anybody who’s interested in talking about it or getting involved, particularly in a large health system,” Lavin said.

He added that one development auguring well for the plaintiffs came in March 2025, when the U.S. Department of Justice filed a statement of interest to the effect that joint use of a pricing algorithm and information exchanges through an intermediary can constitute concerted action under antitrust law.

For providers considering whether to join the MDL, applicable OON claims include those that were processed by MultiPlan or its subsidiary algorithm platforms Data iSight, Viant, National Claims Network (NCN), ProPricer or Medical Audit & Review Solutions (MARS) dating back as long as 10 years from the time the provider joins the litigation. The precise window for eligible claims is to be determined and could partially hinge on state laws.

A newly filed provider case transferred to or directly filed in the MDL generally would be stayed or coordinated while the bellwether cases proceed, Lavin said. The bellwether outcomes are expected to shape the broader litigation by testing common evidence and legal theories and informing possible settlement talks.

“It’s really to set the stage, get a fact-finder’s — a jury’s — impressions of the case, and that certainly factors into settlement discussions and other negotiations that go on in these cases,” Lavin said.

Comparable allegations seen in another case

Similar allegations, although on a smaller scale, are at issue in class-action litigation filed in Massachusetts federal court against Zelis, a healthcare technology and payments company. The case entails allegations that Zelis uses two repricing tools to set rates and then takes a percentage of the insurer’s savings.

As with MultiPlan, Zelis has said its tools use common, publicly available data sources and do not involve collusion among competing insurers.

The fact that the two analogous cases are happening simultaneously is revealing, Lavin said.

“It just shows what providers are up against in this country,” he said.

He doesn’t see another industry where businesses are as constrained in their ability to ensure their prices and resulting revenues keep pace with costs.

“It is the root problem in healthcare, if you ask me, and that’s really what we’re targeting in this case and the other cases that are out there that are similar,” Lavin said.