A massive piece of litigation pending in federal court in Chicago under the caption, In re: Multiplan Health Insurance Provider Litigation, may not be on many providers’ radars because it appears to be mostly about how providers are being reimbursed for out-of-network services. Indeed, most providers get most of their revenues from being in-network with health plans. However, here are five reasons why all providers should be watching this case:
Health plan conspiracy and antitrust claims – The plaintiff providers claim that the health plans conspired with each other and with MultiPlan to use MultiPlan’s rate of calculating and negotiating low out-of-network reimbursement “by agreeing to fix the prices paid for out-of-network healthcare services,” in violation of federal antitrust laws. Other health plan behaviors against providers may similarly give rise to antitrust claims.
Size and scope of the case – There are approximately 317 named plaintiff parties suing 35 named defendant parties. The case is a combined class action, meaning the named plaintiffs are suing on behalf of other similarly situated plaintiffs. The plaintiff parties include hospitals, hospital associations, medical associations, physician practices, hospital-based physician groups, clinics, behavioral health providers, and other providers of patient care services reimbursed by health plans.
Number and breadth of health plan defendants – In addition to MultiPlan, the out-of-network healthcare cost management company for health plans, the named defendants include all of the major health plans in the country, including Aetna, UnitedHealth Group, Elevance (formerly Anthem), Cigna, Blue Cross Blue Shield, Humana, and Centene.
Multiple federal jurisdictions – The case is a consolidation of six actions pending in three federal courts in California, Illinois, and New York. On August 1, 2024, the United States Judicial Panel on Multidistrict Litigation determined that the separate lawsuits should be centralized and coordinated before a single judge in the Northern District of Illinois (Chicago), Matthew Kennelly, for all pre-trial proceedings. Consolidation is designed to facilitate settlements or summary judgments, as well as manage discovery.
Initial decision in favor of providers – As is often the case in litigation against health plans, the plans’ initial response was to move to dismiss the complaints on various grounds. On June 3, 2025, Judge Kennelly ruled in favor of the providers and refused to dismiss the actions, other than one claim on state law grounds. The Judge’s 51-page opinion made some key findings that may translate well to other cases against health plans, such as:
The “realities” of health plan power – The health plans claimed that the providers had recourse from patients to the extent they believed they were underpaid by MultiPlan’s methodology. The Court determined it would not ignore two practical realities in that situation: (1) Health plans are more capable of paying for healthcare services and have greater resources than the average patient; and (2) A provider given the option between guaranteed partial payment from a health plan and the mere possibility of full payment from a patient will likely choose the partial payment, even if it is below their costs.
Health Plans, not patients, are the true purchasers of health care services – the Court rejected health plan claims that patients are the true purchasers of services (calling this argument a “sleight of hand”). Analogizing a parent buying a chocolate bar for his or her child to highlight the plan’s “absurd” logic, the Court recognized the “reality of the health services financing market” that health plans are the negotiators and purchasers of services from providers, regardless of whether the plan is considered a recipient of those services.
Finding the unlawful conspiracy through “circumstantial” evidence – The Court found that even if each health plan acted independently, at different times, and in some customizable ways to use the same MultiPlan methodology, there was sufficient evidence to support the providers’ claim that the plans were working in “parallel conduct” towards a price-fixing scheme. Further, the Court found that “market circumstances” can support conspiracy claims – in this case, the high market concentration held by health plans, allegations of past collusive conduct, and high barriers to entering or exiting the health plan market contribute to an environment conducive to price-fixing.
The findings by Judge Kennelly not only signal opportunities for success for providers in the MultiPlan case but could also serve as helpful linchpins for antitrust-based claims against health plans for other behaviors. The current discovery phase may also produce interesting pieces of future evidence. While this case still has a long road ahead, parts of this case may already be beneficial to providers.
[View source.]