MultiPlan Lawsuit: The Antitrust Case, DOJ Role, and Status

The MultiPlan lawsuit is a consolidated federal antitrust case accusing MultiPlan, Inc. (now Claritev Corporation) and the country’s largest health insurers of using a shared pricing algorithm to fix and suppress payments to out-of-network doctors, hospitals, and other providers. More than 100 provider lawsuits have been folded into MDL No. 3121 in the Northern District of Illinois before Judge Matthew F. Kennelly, discovery is underway, and the first bellwether trial is set for December 7, 2027.¹²

What Providers Say MultiPlan and the Insurers Did

MultiPlan sits between insurers and out-of-network providers. When an insurer receives a claim from a provider it doesn’t have a contract with, it sends the billing data to MultiPlan, whose repricing tools — Data iSight, Viant, ProPricer, and MARS — return a recommended reimbursement amount. Industry reporting puts MultiPlan’s share of commercial out-of-network claim processing above 80% nationwide.²

The complaints say the recommendation is the problem. According to the American Medical Association and Illinois State Medical Society, MultiPlan calculates “median reimbursement levels” by folding in data that shouldn’t count, including in-network rates that reflect steep negotiated discounts. Insurers are also told to apply algorithmic caps, such as a set percentage of the Medicare rate. Each suppressed payment then feeds back into the database as a new data point, pulling the next calculation lower.³

MultiPlan’s fee is a percentage of the gap between what a provider billed and what the insurer ultimately pays, so the lower the payment, the more MultiPlan earns. Providers who receive the repriced offer are given days to respond, and the AMA complaint says more than 95% accept rather than fight a balance-billing dispute.³

Why It’s an Antitrust Case

Plaintiffs bring the case under Section 1 of the Sherman Act on a “hub-and-spoke” theory. MultiPlan is the hub. The spokes are UnitedHealth Group, Aetna, Cigna, Elevance (formerly Anthem), Humana, Centene, and Blue Cross Blue Shield entities. Each insurer hands MultiPlan its own proprietary claims data, reimbursement strategies, and pricing methodology — the kind of competitively sensitive information competitors would never share directly — and each then relies on the resulting algorithm to price out-of-network care. The result, plaintiffs argue, is that insurers who would otherwise compete on reimbursement end up paying roughly the same suppressed rates.³

The complaints trace this back to an earlier scandal. From the late 1990s through 2009, insurers used Ingenix, a UnitedHealthcare subsidiary, to set “usual, customary, and reasonable” rates. The AMA and the New York Attorney General found Ingenix suppressed those rates by 10% to 28% by polluting its database with in-network payments. Twelve insurers, including United, Cigna, Aetna, and Blue Cross Blue Shield, settled with New York in 2009, funded a $95 million independent database called FAIR Health, and agreed not to use alternatives for at least five years. When those restrictions expired in 2015 and 2016, plaintiffs allege, insurers migrated to MultiPlan. Out-of-network reimbursement rates had been rising before 2016 and have fallen every year since.³⁴

The Ruling That Let the Case Move Forward

On June 3, 2025, Judge Kennelly denied the defendants’ motions to dismiss nearly all claims, letting the federal and state antitrust claims and state consumer protection claims proceed. He dismissed only the direct-action plaintiffs’ unjust enrichment claims, on the ground that they didn’t adequately differentiate among various state laws.⁵

Several parts of the ruling matter. The court held that providers, not patients, are the direct victims for antitrust standing purposes, pointing to balance billing prohibitions that leave providers absorbing the loss. On the conspiracy theory, the court found plaintiffs plausibly alleged hub-and-spoke agreements between MultiPlan and each insurer, though it concluded a direct horizontal conspiracy among the insurers themselves was not sufficiently pleaded. Judge Kennelly 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.”⁵

He also identified “plus factors” supporting an inference of conspiracy, chiefly that MultiPlan’s platform gave each insurer an effective view of how competitors were calculating out-of-network rates. The ruling aligned with recent decisions treating algorithmic pricing coordination as actionable, citing cases involving RealPage, Yardi Systems, and Agri Stats.⁶ The court declined to follow a California state court that had dismissed a Verity Health suit on the theory that out-of-network reimbursement rates aren’t “prices” that can be fixed.⁷

The Department of Justice Is Involved on Two Tracks

On March 27, 2025, the DOJ’s Antitrust Division filed a statement of interest supporting the plaintiffs’ legal theory. The filing, listing Antitrust Division head Gail Slater as an attorney on the brief, argued that “the use of a common algorithm can be the basis for a lawsuit under traditional antitrust laws” and that sharing confidential pricing data through an intermediary is “indistinct from sharing pricing information in a direct meeting with a competitor in a smoke-filled room.”⁸

There is also a criminal probe. On May 14, 2026, The Capitol Forum reported that the DOJ Antitrust Division had opened a criminal price-fixing investigation into MultiPlan (now Claritev).⁹ Four days later, Claritev disclosed in an SEC filing that it had received a confidential grand jury subpoena from the DOJ in August 2024 in connection with an “investigation regarding health insurance.” The company said it had cooperated fully and that, as of May 2026, the DOJ had not told it it was a target.¹⁰

How Much Money Is at Stake

The alleged harm is large, and estimates vary. The Allegiance Health Management complaint alleged annual provider underpayments reached $22 billion by 2022. AdventHealth’s complaint put the figure near $19 billion per year. A New York State Comptroller report from April 2020 found MultiPlan’s repricing produced payments 1.5 to 49 times lower than traditional methods would have.⁷³ HFMA reporting noted that MultiPlan processed $106 billion in out-of-network charges in 2019 alone and that alleged underpayments reached $6.4 billion in a single quarter of 2024.¹¹

Because the core claims arise under the Sherman Act, any damages awarded are subject to mandatory trebling. A separate Blue Cross Blue Shield antitrust case settled for $2.8 billion in 2024, and HFMA reporting suggests the MultiPlan litigation could exceed that.²

How MultiPlan and the Insurers Are Defending Themselves

MultiPlan, now operating as Claritev, denies wrongdoing. The company says it does not set reimbursement rates, take on insurance risk, or make final payment decisions, and that its tools draw on “common, publicly available data sources” to produce recommendations that insurers are free to accept or reject.⁷ The insurer defendants have argued that providers lack antitrust standing, that out-of-network reimbursement amounts are not “prices” that can be fixed, and that each insurer’s ability to deviate from MultiPlan’s recommendation defeats any inference of conspiracy.⁵

They have pointed to earlier wins. A California state court dismissed a Verity Health liquidating trust suit in August 2024, holding that out-of-network reimbursement rates were not “prices” subject to price-fixing law. A Long Island Anesthesiologists case was also dismissed after the court found the plaintiff had not plausibly alleged antitrust injury or market power in the relevant market.⁷

Related Cases Worth Knowing About

Two related actions sit outside the federal MDL and are easy to confuse with it. On June 1, 2026, Arizona Attorney General Kris Mayes filed a state-court suit in Maricopa County Superior Court against MultiPlan/Claritev and nine insurers — Aetna, Cigna, UnitedHealthcare, Humana, Elevance, Molina, Centene, and Health Care Service Corporation — alleging violations of Arizona’s Uniform State Antitrust Act and Consumer Fraud Act. The complaint adds allegations that MultiPlan used a tool called PlanOptix to let insurers monitor competitor rates in real time and held about 15 petabytes of competitor data as of February 2026. Mayes sought a permanent injunction, restitution, disgorgement, and civil penalties; Claritev called the suit “without merit.”¹²¹³

A separate class action, In re Zelis Repricing Antitrust Litigation, targets Zelis Healthcare and the same major insurers on the same core theory. On March 30, 2026, Judge Brian E. Murphy in the District of Massachusetts denied the defendants’ motion to dismiss.¹⁴ The Zelis plaintiffs alleged that Zelis itself purchases out-of-network healthcare services, which supported a horizontal conspiracy theory the MultiPlan court had found insufficiently pleaded because no one alleged MultiPlan buys medical services.¹⁵

Where the MultiPlan Lawsuit Stands Now

The federal MDL is in active discovery. At an April 2026 case management conference, the parties addressed the sharing of MultiPlan source code and cell phone records tied to communications between defendants.¹⁶²

Any out-of-network provider whose claims ran through MultiPlan, Data iSight, Viant, NCN, ProPricer, or MARS may be eligible, and damages can potentially reach back up to ten years. New cases can still be filed, and providers may pursue individual claims while the class action proceeds separately.¹⁷ Affected specialties named in filings include emergency medicine, anesthesiology, orthopedics, radiology, and pain management, along with ambulatory surgery centers and behavioral health and addiction treatment facilities.¹⁸

1
U.S. Judicial Panel on Multidistrict Litigation. MDL 3121 Transfer Order
2
HFMA. MultiPlan, Zelis Antitrust Out-of-Network Pricing
3
AMA. American Medical Association v. MultiPlan, Inc., Complaint
4
Archive.org (Court Filing). Ingenix Settlement Complaint
5
King & Spalding. In re MultiPlan Health Insurance Provider Litigation, Memorandum Opinion and Order
6
King & Spalding. MultiPlan Algorithmic Pricing Antitrust Claims Survive Motion to Dismiss
7
Becker’s Payer Issues. What To Know About MultiPlan’s Litigation Saga
8
Bloomberg Law. DOJ Says Algorithmic Pricing Can Be Foundation of Antitrust Suit
9
The Capitol Forum. DOJ Launches Criminal Antitrust Probe Into Claritev
10
Stock Titan (SEC Filing). Claritev Corp 8-K Filing
11
HFMA. The Latest on Providers’ Landmark Antitrust Suit Alleging Price-Fixing by MultiPlan and Healthcare Insurers
12
Arizona Attorney General. Attorney General Mayes Sues MultiPlan and Major Health Insurers for Alleged Price-Fixing
13
Arizona Mirror. Arizona Sues MultiPlan, Major Insurers Alleging a Cartel That Underpaid Doctors and Hospitals
14
Fierce Healthcare. 5 Major Insurers, Vendor Zelis Must Face Repricing Antitrust Claims, Judge Rules
15
GovInfo (Court Filing). In re: Zelis Repricing Antitrust Litigation, Order on Motion to Dismiss
16
Texas Medical Association. MultiPlan Antitrust Litigation Update
17
Medical Society of the State of New York. MultiPlan Antitrust Litigation Update
18
PBG Law. MultiPlan Out-of-Network Underpayment Litigation, MDL 3121