Article Referred by Bob Calvisi
“MultiPlan knows it can get away with acting, in the words of an analyst, ‘like a mafia enforcer for insurers,’ because virtually every commercial healthcare payor has agreed to use its repricing methodology, leaving healthcare providers with no practical option but to accept the ‘repriced’ reimbursement amount that MultiPlan imposes……….”
MultiPlan’s contracts are ‘like a mafia enforcer for insurers,’ AdventHealth alleges in antitrust lawsuit By Dave Muoio
AdventHealth has brandished a lawsuit alleging that MultiPlan’s business model of contracting with fellow payers and aggressively repricing out-of-network service payments is anticompetitive under Section 1 of the Sherman Act.
Per the complaint filed Wednesday in the U.S. District Court for the Southern District of New York, the payer network and analytics services company masterminds what AdventHealth repeatedly referred to as the “MultiPlan Cartel.”
AdventHealth said this “multi-year, ongoing conspiracy” comprises “virtually all of the major healthcare insurance payors in the United States” and mentioned Aetna, Elevance Health, Centene Corporation, Cigna Group, Health Care Service Corporation, UnitedHealth Group and Humana by name.
MultiPlan, however, has acknowledged that its contract agreements with these horizontal competitors exist and therefore is “jointly and severally liable per se for all of the damages caused by those agreements,” AdventHealth wrote.
The system is seeking damages for the alleged underpayments and lost revenues, which it places at “hundreds of millions of dollars.” It claims to have “overwhelming direct evidence” of MultiPlan’s allegedly anticompetitive contracts, including regulatory filings.
“MultiPlan knows it can get away with acting, in the words of an analyst, ‘like a mafia enforcer for insurers,’ because virtually every commercial healthcare payor has agreed to use its repricing methodology, leaving healthcare providers with no practical option but to accept the ‘repriced’ reimbursement amount that MultiPlan imposes,” Advent Health wrote in the complaint.
A representative for MultiPlan told Fierce Healthcare the company “believes this lawsuit has no merit and looks forward to disproving these baseless allegations.”
AdventHealth, a 50-hospital nonprofit operating in nine states, said New York-based MultiPlan began to upend typical negotiation between health systems and an individual payer in 2006 when it acquired a series of companies to build out a reimbursement claim analytics tool.