By Doug Aldeen
MultiPlan and its partner health insurers are pushing back against antitrust allegations from numerous provider organizations, filing Thursday a motion to dismiss their collective lawsuit against the data company.
Individual health systems and the American Medical Association (see link below) have filed cases against MultiPlan in recent months, leading to multidistrict litigation consolidating dozens of plaintiff complaints. They accuse the company of forming agreements with insurers—UnitedHealth Group, Elevance Health, Aetna and Cigna are listed as “co-conspirators”—to set out-of-network prices using a common collective data set and methodology, as opposed to competing with each other individually. By doing so, the “MultiPlan Cartel” drove roughly $19 billion of underpayments in 2020 and $6.4 billion of underpayments during the third quarter of 2024, the plaintiffs wrote in a consolidated complaint filed in December.
Counsel for the AHA argues that “MultiPlan conspired with major insurers to orchestrate a price-fixing cartel that has devastated healthcare access across America,” the counsels said in a statement. “Nearly 30% of rural hospitals are at risk of closure, and thousands of healthcare providers who depend on out-of-network payments are teetering on the edge of financial collapse.
This litigation aims to dismantle this conspiracy and hold the defendants accountable, restoring competition to the out-of-network payments market to ensure doctors receive fair compensation and every American has access to the quality healthcare they deserve.”
Thoughts moving forward:
1) Define underpayment and who makes that determination?
2) In the alternative, if the hospitals simply priced their services reasonably, Multiplan would cease to exist;
3) HCA can operate a facility at 93% of Medicare which covers 150% of its costs. Maybe the top brass at HCA should get into the not for profit business;
4) At the end of the day, if the ability to reprice facility claims is compromised, we are all screwed
Antitrust Lawsuit Against Multiplan
“HCA can operate a facility at 93% of Medicare which covers 150% of its costs.”
