April 7, 2025 | Washington, D.C. — MedLegalNews.com — MultiPlan Price Fixing Case: The U.S. Department of Justice (DoJ) recently entered the ongoing antitrust legal battle against MultiPlan (now known as Claritev), a tech company that assists health insurers in controlling healthcare costs. This case has gained national attention, as it alleges that MultiPlan’s algorithms are facilitating illegal price-fixing in the healthcare sector.
How MultiPlan’s Algorithms Are Alleged to Impact Prices
MultiPlan’s primary service involves utilizing algorithms to recommend the amount health insurers should pay for out-of-network treatments. The crux of the issue lies in the fact that out-of-network care often costs more because these providers don’t have agreements with the insurers on payment rates. Traditionally, insurers cover less of these costs, which means patients often bear a significant financial burden. MultiPlan Price-Fixing Case
The lawsuit alleges that MultiPlan’s software uses non-public data shared by competing health insurers (including Aetna, Cigna, and UnitedHealthcare) to effectively set prices, thereby inflating costs for patients. As a result, insurers are accused of suppressing reimbursement rates, which may violate antitrust laws.
Federal Intervention Strengthens Case Against MultiPlan
The Justice Department’s recent intervention is significant. In its Statement of Interest, the DoJ challenges two key arguments made by MultiPlan and its co-defendants:
- No Conspiracy Alleged: MultiPlan argues that there’s no conspiracy because health insurers don’t use MultiPlan’s software to set prices in the same way. The Justice Department counters this argument, explaining that even without direct communication between competitors, sharing pricing strategies through a third party, such as an algorithm provider, can lead to anti-competitive effects.
- Lack of Competitive Sensitivity: The second argument challenged by the DoJ is that the non-public data shared with MultiPlan is not competitively sensitive. However, federal prosecutors assert that this does not provide immunity from antitrust laws. They explain that algorithms can maximize industry-wide pricing by using information from multiple competitors, thereby effectively coordinating pricing strategies.
The Bigger Picture in Healthcare Antitrust Enforcement
The DoJ’s intervention aligns with its growing focus on algorithmic price-fixing cases. In the past, the federal agency has filed similar Statements of Interest in other industries, including real estate and hotel pricing cases. These cases follow a common theme where companies delegate price-fixing to a central third party, rather than conspiring directly.
Christopher Seeger, the court-appointed counsel overseeing the MultiPlan multi-district litigation, responded to the Justice Department’s intervention by emphasizing the case’s importance. He stated, “The practical impact of this healthcare pricing cartel is devastating to the providers our communities rely on. Nearly 30% of rural hospitals are at risk of closure, and thousands of doctors face financial collapse due to unfair compensation.”
What’s Next in the MultiPlan Case?
MultiPlan continues to deny the allegations, maintaining that the lawsuits are without merit. A company spokesperson reiterated, “We’ve been clear that these lawsuits would ultimately increase prices for patients and employers. We will continue to defend ourselves through the legal process.”
The court has yet to rule on the motions to dismiss the case filed by MultiPlan and its co-defendants. However, the DoJ’s involvement is a clear signal that antitrust scrutiny on healthcare pricing practices is intensifying.
For full details of the government’s position in the case, see the Statement of Interest filed by the U.S. Department of Justice in the In re MultiPlan Health Insurance Provider Litigation.
For ongoing updates on healthcare regulations and antitrust litigation in the medical sector, visit MedLegalNews.com.
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FAQs: Multiplan Price Fixing Case
What is the Multiplan price fixing case?
The Multiplan price fixing case involves allegations that MultiPlan (now Claritev) and major insurers used pricing algorithms and non-public data to coordinate out-of-network reimbursement rates.
Why did the DoJ enter the Multiplan price fixing case?
The U.S. Department of Justice entered the Multiplan price fixing case via a Statement of Interest, arguing that sharing pricing data and using common algorithms may violate Section 1 of the Sherman Act.
Department of Justice
Who is impacted by the Multiplan price fixing case?
Out-of-network providers, insurers, companies using MultiPlan’s services, and ultimately patients who may face inflated costs are all impacted by the Multiplan price fixing case.
What could be the outcome of the Multiplan price fixing case?
If successful, the Multiplan price fixing case could lead to substantial provider recoveries, increased scrutiny of pricing algorithms across healthcare, and changes in how out-of-network reimbursements are determined.