Updates on MultiPlan MDL Antitrust Case: Allegations of Price Suppression by Major Insurers

The MultiPlan litigation in federal court may look like a dispute between insurers and out-of-network (OON) doctors—but it’s really about how money flows (or doesn’t) in our healthcare system, who controls pricing, and who benefits when prices are slashed behind closed doors.

At the center of the case is an alleged price-suppression scheme involving some of the largest health insurers in the country—including UnitedHealthcare, Aetna, Cigna, Horizon BCBS, Elevance, and others—and a third-party repricing vendor called MultiPlan. According to the consolidated complaint filed by a group of healthcare providers, these insurers “collectively ceded” control over OON pricing to MultiPlan in order to coordinate a system that allowed them to “fix and suppress” provider payments across the board.

The mechanism? MultiPlan’s proprietary algorithm, Data iSight, which the complaint alleges functions as a “centralized vehicle” for price suppression. Here’s how the plaintiffs describe the operation:

“MultiPlan aggregates competitively sensitive payment data and strategic pricing preferences from hundreds of insurers, feeds that data into an algorithm, and produces pricing outputs that insurers adopt—knowing the outputs are based on their competitors’ inputs.” (¶186)

The plaintiffs argue that the insurers are not simply using a vendor to enhance efficiency; they are outsourcing price-setting to a shared intermediary in a way that undermines market competition:

“Each Insurer Defendant adopted MultiPlan’s algorithmically-informed pricing determinations knowing they were derived from rival insurers’ competitively sensitive information… and they did so with the purpose of suppressing prices for OON services.” (¶213)

Here’s how it allegedly works in practice:

• Providers are out-of-network and not bound by contracted rates.

• Insurers, rather than setting OON reimbursement amounts independently, send claims to MultiPlan.

• MultiPlan, using its access to real-time claims data and insurers’ confidential pricing preferences, calculates a recommended price.

• Insurers adopt that price—often significantly lower than historical OON payments—then pay the provider that amount.

  
  

Providers can either accept the reduced payment or attempt to collect the difference from the patient (a practice known as balance billing). But the complaint asserts that providers are often contractually or legally barred from doing so:

“Providers are frequently prohibited from balance billing by the Cartel itself” (¶172), and “even when not legally barred, the practical reality is that many providers will not pursue patients for balance bills.” (¶174)

The complaint calls this arrangement a “cartel”—not in the traditional sense of sellers inflating prices, but in a monopsony-style agreement where dominant buyers (the insurers) use a central actor (MultiPlan) to coordinate downward pressure on prices.

Importantly, this is not a claim about inefficiency or administrative preference—it’s about competition. The plaintiffs argue that this arrangement “eliminated meaningful competition” among insurers for OON services (¶279), allowing them to suppress provider reimbursement while appearing to act independently.

Insurers' Defense: "Just Bill the Patient"

In their joint motion to dismiss, the insurers argue that providers lack antitrust standing because they aren’t directly harmed—claiming that providers can simply recover any underpayment by billing the patient directly. According to the motion, “any harm flows to the patient, not the provider.”

This argument isn’t just legally debatable; it raises serious policy concerns for employers and patients, particularly those in self-funded plans with out-of-network (OON) coverage they’ve paid for and expect to function as promised.

Let’s acknowledge an important reality first: some OON providers do engage in aggressive or inflated billing practices, and there is a legitimate role for repricing, negotiation, and cost management to ensure payments are aligned with reasonable market value. No one disputes that employers and plans should have mechanisms to protect against outliers.

But that is not what this case is about. This case is not about occasional high charges or fair negotiation. It is about whether a group of insurers and a shared vendor (MultiPlan) crossed the line from cost management into collusion, by coordinating reimbursement amounts through a centralized algorithm fed by confidential competitor data—thereby suppressing prices across the board, regardless of what’s fair or reasonable.

The complaint alleges that insurers:

• Aggregated non-public payment strategies and data through MultiPlan;

• Relied on MultiPlan’s algorithm to generate “repriced” amounts;

• And accepted those prices uniformly—without regard to service, market variation, or provider quality.

  
  

Then, when challenged, they point the finger at the provider, saying: “Don’t like it? Just bill the patient.”

That may be legally convenient—but it’s troubling when applied to the real world:

• Many providers are prohibited by law or contract from balance billing.

• Others choose not to pursue patients, out of principle or practicality.

• And perhaps most importantly, patients are not supposed to be the failsafe in a benefit design they already paid into.

As the complaint puts it:

“Providers are frequently prohibited from balance billing by the Cartel itself,” and “even when not legally barred, the practical reality is that many providers will not pursue patients for balance bills.” (¶¶172, 174)

From the patient’s perspective, these services were covered. From the employer’s perspective, they paid administrative fees for a plan that promised access to OON care. And from the insurer’s perspective? It appears they used that plan as a revenue opportunity—because every time MultiPlan reprices a claim down, they and the carrier often share in the “savings.”

When those fees—sometimes larger than the actual payment to the provider—are collected and retained by intermediaries, not returned to the employer or patient, the system starts to look a lot less like cost control and a lot more like value extraction.

So yes, fair repricing is important. But transparency, market competition, and fiduciary responsibility are just as essential. And that is what this case puts under the microscope—not isolated billing disputes, but systemic practices that may prioritize profit over fairness, competition, and the people the plans are supposed to serve.

As this case proceeds, the first major question is whether the court will allow the complaint to survive the motion to dismiss. If it does, the litigation moves into discovery—a phase that could compel disclosure of internal communications, pricing algorithms, fee structures, and contracts that have long operated behind closed doors. That’s a prospect the defendants are likely eager to avoid.

And that raises the real possibility of a settlement. But if this case settles before discovery, what changes? The underlying practices—opaque pricing, shared “savings” incentives, and the offloading of risk onto patients and providers—could very well continue, unexamined and uncorrected.

Because while this case was brought by providers, the potential harm extends far beyond them. It’s the employers who funded these plans and the patients who relied on them that may have been footing the bill—without ever knowing how little was actually paid, or how much was pocketed in the name of “cost savings.”

This case isn’t just about reimbursement. It’s about whether transparency, competition, and accountability still have a place in how we pay for care.