Federal Court Permits MultiPlan Antitrust MDL to Proceed: Court Upholds Federal and State Antitrust and Consumer Protection Claims, Paving Path to Discovery

On June 3, 2025, Judge Matthew F. Kennelly of the U.S. District Court for the Northern District of Illinois issued a sweeping ruling in In re MultiPlan Health Insurance Provider Litigation, largely denying motions to dismiss brought by MultiPlan and dozens of insurer co-defendants. This multidistrict litigation (“MDL”) alleges a far-reaching, anti-competitive price-fixing conspiracy among some of the nation’s largest health insurers and MultiPlan (now rebranded as Claritev) to underpay doctors and other out-of-network (“OON”) providers by tens of billions of dollars for the medical and behavioral healthcare services they provide to their OON patients.

The court’s ruling upheld nearly all federal and state antitrust and consumer protection claims brought by both the direct-action plaintiffs (“DAPs”) and the putative class, clearing the way for expansive fact discovery. Only the state law unjust enrichment claims were dismissed. Healthcare Litigation partner Matt Lavin, who serves on the DAP executive committee, and AGG represent many of the provider plaintiffs in the case, including medical associations, hospital systems, physician-led medical groups, specialty practices, and substance abuse treatment centers.

The Alleged Scheme

The plaintiffs allege that MultiPlan, the dominant vendor of in-patient and out-patient pricing and repricing tools, coordinated a “hub-and-spoke” conspiracy in which it used its OON repricing products and services to impose artificially deflated payment rates across more than 80% of OON claims submitted to more than 700 health plans across the country. These plans, offered by major payors including UnitedHealth, Aetna, Cigna, and Blue Cross Blue Shield entities, allegedly delegated their pricing and negotiation authority to MultiPlan while maintaining visibility into competitors’ rates and repricing practices.

The Court’s Reasoning: Antitrust Standing and Injury

Judge Kennelly rejected defendants’ primary contention that providers lacked standing because they could theoretically seek payment from patients. The court emphasized the real-world economic constraints that providers face, concluding that the MultiPlan pricing regime left them with no realistic alternative to accepting the low rates offered.

The court also upheld the plaintiffs’ allegations of antitrust injury, finding that the alleged scheme plausibly resulted in below-market compensation due to reduced competition in the market for OON healthcare services. The court directly addressed the defendants’ contention that providers could simply seek full payment from patients, calling it “a distinction without a difference” and noting it “ignores the practical effect of MultiPlan’s balance billing prohibition.”

Judge Kennelly was also unsparing in rejecting the defendants’ argument that patients, rather than providers, were the directly injured parties. He found that providers are “the only private parties under this scenario that have an incentive to enforce antitrust law,” given that “patients in this case have no real incentive to sue third-party payors for alleged underpayment.”

Relevant Market Allegations

The court ruled that the plaintiffs plausibly alleged a relevant product market: OON healthcare services sold to third-party payors. The defendants argued that there was no fixable price for OON services, framing the dispute as one over insurance plan benefits rather than provider reimbursement. Judge Kennelly was blunt in his rejection of this argument, stating that “the defendants’ argument amounts to sleight of hand” and finding that the plaintiffs adequately alleged a fixable price and a functioning competitive market.

The court also found the geographic scope — a nationwide market — plausible and noted that the defendants’ challenges to market definition raised fact disputes inappropriate for resolution on a motion to dismiss.

Horizontal Agreement and Hub-and-Spoke Conspiracy

Despite concluding that the plaintiffs had not sufficiently alleged a direct horizontal price-fixing agreement between MultiPlan and the payors themselves, the court found that the plaintiffs had plausibly claimed a far broader arrangement in which MultiPlan facilitated horizontal coordination among its payor clients. The court found the allegations supported the existence of a “hub-and-spoke conspiracy” to depress reimbursement rates for OON healthcare services through MultiPlan’s rate-setting tools and negotiation framework:

Although the defendants scoff at the idea that there can be a plausible allegation of an agreement among MultiPlan’s 700+ third-party-payor clients, MultiPlan has allegedly made each of the third-party payors aware of a broader horizontal agreement through its statements that it can ‘align’ a third-party payor’s rates with other MultiPlan clients by using disclosed competitively sensitive information. Each third-party payor that contracts with MultiPlan thus knows that MultiPlan is capable of aligning rates without the risk of subscriber loss because other third-party payors have agreed to disclose pricing information and delegate rate calculations to MultiPlan’s algorithm as well.

Thus, the plaintiffs plausibly alleged that payors coordinated through their shared reliance on MultiPlan’s services and its dissemination of payors’ competitively sensitive pricing information, facilitating an industry-wide suppression of payments to medical providers.

The Road Ahead

This decision is a significant milestone in the MDL and reinforces that providers are essential private enforcers of competition in the healthcare market. The case now proceeds to discovery, where internal communications and data exchange practices among MultiPlan and co-defendants are expected to face intense scrutiny.

For providers who have been impacted by MultiPlan’s repricing practices and have not yet joined the MDL as direct-action plaintiffs, this decision marks a critical opportunity to join the growing number of healthcare providers filing antitrust and consumer protection actions against MultiPlan and nearly all of the nation’s largest insurers, managed care organizations, and third-party administrators.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations. Attorney Advertising.

© Arnall Golden Gregory LLP

Written by:

Arnall Golden Gregory LLP
Contact
more
less

PUBLISH YOUR CONTENT ON JD SUPRA NOW

  • Increased visibility
  • Actionable analytics
  • Ongoing guidance

Arnall Golden Gregory LLP on:

Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
- hide
- hide