Claritev Lawsuit: Antitrust Claims, DOJ Probe, and Arizona Suit

The Claritev lawsuit is a sprawling federal antitrust case in which hundreds of doctors, hospitals, and physician groups accuse the healthcare data analytics company (formerly known as MultiPlan) and roughly 700 health insurers of conspiring to hold down payments for out-of-network medical care through a shared pricing algorithm. The consolidated litigation survived a motion to dismiss in June 2025, drew a supporting statement of interest from the U.S. Department of Justice, and is scheduled for bellwether trials beginning in December 2027.¹

What Providers Say Claritev Did

When a patient sees an out-of-network doctor, the insurer sends the bill to Claritev instead of deciding on its own what to pay. Claritev’s tool, Data iSight, draws on a database of more than a billion paid claim lines and public facility data to generate a recommended reimbursement, typically in the range of 160% to 260% of Medicare rates.² Plaintiffs allege those recommendations sit well below what “usual, customary, and reasonable” benchmarks would produce. A 2020 study by the New York State Comptroller’s office found that payments calculated using MultiPlan’s methodology were 1.5 to 49 times lower than those produced by traditional methods.³

Providers describe the resulting offers as non-negotiable. Courts have called them “take-it-or-leave-it” propositions.⁴ Accepting the reduced payment usually comes with a prohibition on balance billing, meaning the doctor cannot pursue the patient for the unpaid portion. Plaintiffs say that traps them into accepting below-market rates with no realistic alternative.³ Claritev’s fee model reinforces the dynamic: the company earns based on the “savings” it generates for insurers, so the wider the gap between the billed charge and the final payment, the more Claritev collects.

By 2019, MultiPlan was processing more than 80% of commercial out-of-network claims in the United States, handling over 370,000 claims a day and $106 billion in out-of-network charges that year.¹

Who Is Suing and Who Is Being Sued

The case is consolidated as In re MultiPlan Health Insurance Provider Litigation, MDL No. 3121, Case No. 24-C-6795, in the U.S. District Court for the Northern District of Illinois before Judge Matthew F. Kennelly. It pulls together more than 100 individual lawsuits along with a proposed class action.⁵¹

Plaintiffs include the American Medical Association, the California Medical Association, and hundreds of physician practices.⁶ Major health systems with individual suits include AdventHealth, Community Health Systems, Allegiance Health Management, Ascension, Texas Health Resources, and Lifepoint Corporate Services.⁷

On the defense side, named alongside Claritev are Aetna, Cigna, UnitedHealth Group, Elevance Health (formerly Anthem), Humana, the Blue Cross Blue Shield Association and its member plans, Centene, Health Care Service Corporation, Highmark Health, Molina Healthcare, Kaiser Foundation Health Plan, Cambia Health Solutions, CareFirst, Sanford Health Plan, and several smaller insurers and third-party administrators.⁸

The Legal Theory

The heart of the case is a “hub-and-spoke” price-fixing claim under Section 1 of the Sherman Antitrust Act. Plaintiffs cast Claritev as the hub that receives and transmits competitively sensitive pricing information among insurers who are supposed to compete with one another. Each insurer’s contract with Claritev is a spoke, and the rim, plaintiffs say, is a de facto agreement to stop competing on out-of-network payments.⁸

The consolidated complaint, filed in November 2024, alleges the scheme has been running since at least 2015 and that by 2018 the top 15 U.S. insurers all had contracts with MultiPlan.⁶ In March 2025, the Department of Justice filed a statement of interest arguing that using a common pricing algorithm can amount to “concerted action” under antitrust law and that exchanging sensitive data through an intermediary can violate the Sherman Act even without direct communication between competitors.⁹

The June 2025 Ruling That Let the Case Proceed

On June 3, 2025, Judge Kennelly denied the defendants’ motions to dismiss the federal and state antitrust claims and the state consumer protection claims, sending the case into discovery.¹⁰

On the algorithm question, the judge wrote that “an agreement to fix prices within a below-market range through use of an algorithm is no different for antitrust purposes than an agreement to fix prices to a single point.” Defendants had argued that because insurers could in theory customize or reject Data iSight’s recommendations, no conspiracy existed. Judge Kennelly was not persuaded, writing that the “theoretical ability to deviate from a MultiPlan-calculated rate does not mean payors actually reject MultiPlan’s recommendations in practice.”¹¹

On standing, defendants argued that only patients, not providers, were injured. The judge disagreed, holding that balance-billing prohibitions force providers to choose between guaranteed but below-market payments and the risk of collecting nothing from patients, making them “direct victims.”¹¹

The one win for defendants: the judge dismissed the plaintiffs’ unjust enrichment claims, finding they had failed to distinguish among the unjust enrichment laws of the 31 states and the District of Columbia where those claims were brought.¹¹

What Happens Next

The case is now in active discovery. In February 2026, the court authorized depositions of Claritev representatives and ordered the production of key internal records.¹² Bellwether trials are set to begin in December 2027.¹ A ruling on class certification is not expected until 2027, though individual providers can pursue non-class claims in the meantime.⁹

How Much Money Is at Stake

The damage numbers are large. AdventHealth’s 2023 complaint alleges provider underpayments of roughly $19 billion per year. Allegiance Health Management’s 2024 complaint puts the figure at $22 billion by 2022. Community Health Systems alleges “hundreds of millions of dollars” in damages on its own.⁵⁷ Any damages awarded under federal antitrust law are subject to mandatory tripling, which could push total exposure into the tens of billions.⁴

A plaintiffs’ attorney on the case’s executive committee said individual providers could see damages “in the tens, twenties, hundreds of millions of dollars or more,” and described the litigation’s potential exposure as “significantly greater” than the Blue Cross Blue Shield antitrust settlement, which resolved for $2.8 billion.¹

Claritev has flagged the stakes in its own securities filings, acknowledging that failure to deleverage could raise questions about its “ability to continue as a going concern” and identifying litigation outcomes and possible credit rating downgrades as material risks.¹³

The DOJ Investigation

Separate from its civil statement of interest in the MDL, the Justice Department has been running its own probe. Claritev confirmed it received a confidential grand jury subpoena from the DOJ’s antitrust division in 2024.¹⁴ In May 2026, The Capitol Forum reported that DOJ had opened a criminal price-fixing investigation.¹⁵ Later reporting from Global Competition Review indicated the investigation has focused on possible civil violations despite the grand jury mechanism.¹⁶ Claritev says it has not been told it is a target of the investigation.⁵

Arizona’s State Lawsuit

On June 1, 2026, Arizona Attorney General Kris Mayes filed a separate state suit against Claritev and eight insurers (Aetna, Cigna, UnitedHealthcare, Humana, Elevance, Molina, Centene, and Health Care Service Corporation) in Maricopa County Superior Court.¹⁷ The complaint alleges violations of the Arizona Uniform State Antitrust Act and the Arizona Consumer Fraud Act, claiming the defendants formed a buyer’s “cartel” that used a shared algorithm to suppress provider payments and drive up out-of-pocket costs for patients.¹⁸

Arizona also raises consumer-facing allegations not in the federal MDL, including claims that insurers misrepresented the value of PPO coverage and failed to disclose that a third-party algorithm determined provider payments. The state is seeking a permanent injunction, restitution for patients and providers, disgorgement of profits, and civil penalties.¹⁷

What Claritev Says

Claritev denies setting reimbursement rates, denies making final payment or coverage decisions, and denies assuming any insurance risk. The company says Data iSight relies on “common, publicly available data sources” and that its repricing recommendations are advisory only.⁵¹⁸¹⁹ The federal MDL judge in Illinois reached the opposite conclusion when he allowed the consolidated case to proceed.

1
HFMA. The Latest on Providers’ Landmark Antitrust Suit Alleging Price Fixing by MultiPlan and Healthcare Insurers
2
Sprypt. OON Repricing Entities
3
Medscape. Judge Allows Physicians’ Price-Fixing Lawsuit Against MultiPlan to Proceed
4
HFMA. MultiPlan, Zelis Antitrust Out-of-Network Pricing
5
Becker’s Payer Issues. What to Know About MultiPlan’s Litigation Saga
6
California Medical Association. CMA Joins Lawsuit Against MultiPlan and Leading Insurance Providers Over Health Care Price Fixing
7
Fierce Healthcare. Community Health Systems Adds Another Antitrust Lawsuit to MultiPlan’s Collection
8
Allen & Overy Shearman. In re MultiPlan Insurance Provider Litigation
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Medical Society of the State of New York. MultiPlan Antitrust Litigation Update
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Modern Healthcare. Claritev MultiPlan Antitrust Lawsuits
11
King & Spalding. In re MultiPlan Health Insurance Provider Litigation, Memorandum Opinion and Order
12
Michigan State Medical Society. MultiPlan Antitrust Litigation Update
13
Claritev Investor Relations. MultiPlan Announces Expiration and Results of Exchange Offers and Consent Solicitations
14
Seeking Alpha. Claritev Jumps After Responding to Claims About DOJ Investigation
15
The Capitol Forum. DOJ Launches Criminal Antitrust Probe Into Claritev
16
Global Competition Review. Claritev Faces Civil Conduct Probe
17
Arizona Attorney General. Attorney General Mayes Sues MultiPlan and Major Health Insurers for Alleged Price Fixing
18
Arizona Mirror. Arizona Sues MultiPlan, Major Insurers, Alleging a Cartel That Underpaid Doctors and Hospitals
19
Healthcare Dive. MultiPlan Rebrands as Claritev