June 3 (Reuters) - A U.S. judge on Tuesday said
healthcare providers can pursue claims that technology provider
MultiPlan and a group of insurers conspired to underpay them
billions of dollars in reimbursements for out-of-network health
services.
U.S. District Judge Matthew Kennelly in Chicago ruled that
doctors and other providers who filed the proposed class action
had plausibly alleged a price-fixing conspiracy that relied on
insurers collectively sharing sensitive information with
MultiPlan to set reimbursement rates.
MultiPlan, which rebranded as Claritev ( CTEV ) in February,
processes payments for out-of-network healthcare services. Major
insurers, including defendants UnitedHealth ( UNH ), Aetna and Cigna ( CI ),
have contracts with the company and use its software.
In a statement on Tuesday, MultiPlan said it was "confident
in the strength of our legal position" and that the lawsuits
have no merit.
Aetna parent CVS in a statement said, "we stand ready to
argue the substantive facts of the case and defend ourselves
vigorously in this matter."
UnitedHealth ( UNH ) and Cigna ( CI ) did not immediately respond to
requests for comment. All of the defendants have denied any
wrongdoing.
Kennelly is presiding over consolidated lawsuits that were
first filed in 2023.
MultiPlan processes more than 80% of out-of-network claims
across the country, or abut 370,000 daily claims, according to
the plaintiffs.
In a statement, attorneys for the health providers said
MultiPlan and the insurance defendants "orchestrated a cartel
through the sharing of competitively sensitive confidential
pricing information to illicitly coordinate on out-of-network
reimbursements."
MultiPlan and the insurers have argued that health providers
are free to reject an insurance company's payment and instead
seek full compensation from patients. MultiPlan told the court
its services provide industry more flexibility, lowering costs
to insurers and patients.
Kennelly in his ruling said "whether or not MultiPlan's
calculated rates are labeled as 'recommendations,' the
plaintiffs plausibly allege that they are more akin to
mandates."
The U.S. Justice Department submitted a court filing in
March backing claims in the health providers' case.
The case is In re MultiPlan Health Insurance Provider
Litigation, U.S. District Court for the Northern District of
Illinois, No. 1:24-cv-06795.
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