MultiPlan Antitrust Litigation

At its core, this case is about price-fixing. MultiPlan, now rebranded as Claritev, though we still call it MultiPlan because that's the name everyone knows, operates as a hub for nearly every major health insurer in the country: United, Aetna, Cigna, Elevance, the Blue Cross entities. What MultiPlan does is collect confidential pricing data from all of them, run it through its proprietary algorithms, and then generate reimbursement rates for out-of-network claims. Every one of those insurers then applies those rates. The result is that competitors who should be competing on what they pay providers instead converge on the same artificially suppressed rates. That alleged behavior is the definition of a cartel.

MultiPlan processes roughly 80% of all out-of-network claims in the United States. We're not talking about a niche product. This affects virtually every physician who sees patients out of network.

They're complementary, but they serve different purposes, and the distinction matters for what individual physicians can ultimately recover.

The federal MDL encompasses two types of relief. The case seeks injunctive relief on behalf of all plaintiffs. That means a court order requiring MultiPlan to stop the scheme and requiring transparent, independently verifiable reimbursement benchmarks going forward. ArMA and other medical associations are part of the MDL in that capacity: fighting to end the practice and restore fair market competition for their members.

Individual providers such as physician practices, hospital systems, and surgery centers, are also pursuing monetary damages in the MDL for the out-of-network underpayments they've suffered. Federal antitrust law allows for treble damages, meaning the court can award three times the actual harm proven at trial.

The Arizona AG’s lawsuit is a state enforcement action. Attorney General Mayes is pursuing this on behalf of the state and Arizona consumers, and we’re glad she is, because it reinforces that what MultiPlan is doing is illegal and harms Arizonans. But a state AG action is focused on stopping the conduct and recovering on behalf of the public. It does not put money in an individual physician’s pocket.

That’s the key point for members: The AG’s lawsuit does not entitle a provider to individual damages. If Arizona physicians want to be in a position to recover compensation for what they’ve lost, they need to be part of the federal litigation.

Healthcare specialties impacted by this MultiPlan pricing include:

• Ambulatory/Outpatient Surgery
• Addiction Treatment
• Behavioral Health
• Emergency Medicine 
• Hospital Medicine
• Radiology
• Anesthesia
• Chiropractor
• Orthopedics

We've had a series of significant wins. In March 2025, the Department of Justice filed a Statement of Interest aligning with our legal theory, that routing price-fixing through a third-party intermediary doesn't immunize it from antitrust scrutiny. That was an important signal from the federal government about what is at stake here.

Then in June 2025, the judge overseeing the case denied most of the defendants' motions to dismiss. He upheld the federal and state antitrust claims and made clear that using an algorithm to fix prices within a below-market range is no different, legally, from fixing prices to a single point. The case is now in the discovery phase. We're talking about depositions, document production in the tens of millions of pages, and building the factual record that will go to trial. The first bellwether trial is currently scheduled for May 2028. Thirty-six bellwether cases have been selected to proceed through trial as representative claims for the broader provider group.

This affects any provider who treats patients out of network. That means emergency medicine, behavioral health, anesthesiology, orthopedics, physical therapy, chiropractic—any specialty where out-of-network care is common. It hits independent practices and smaller groups particularly hard, because they don't have the leverage that large hospital systems have in negotiations, and they depend on adequate reimbursement to keep their doors open.

Rural providers are among the most vulnerable. When a rural practice can't sustain operations because its out-of-network rates have been driven below cost, patients in that community lose access to care. The harm here runs from individual physicians all the way to community health infrastructure.

The process is straightforward. ArMA has joined as an association plaintiff, which is significant, it means the association is lending its voice and resources to the litigation on behalf of its members. But individual physicians and practices can also file direct claims, and I'd encourage any Arizona provider who has seen out-of-network reimbursements suppressed to reach out and learn more.

The court has also 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. 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. Joining now means being part of the case as discovery develops, with control over your own claims and how they are litigated.

Members can connect with our legal team directly through this link.