MultiPlan faces another ‘price fixing’ lawsuit, filed by Community Health Systems

Community Health Systems, one of the largest hospital systems in the U.S., has become the third health system in less than a year to file a lawsuit accusing MultiPlan of price fixing. The suit, filed in New York federal court, alleges that the data-driven claims repricing business reached agreements with nearly every other significant payer to suppress out-of-network reimbursements paid to health-care providers.

“MultiPlan knows that by bombarding health-care providers with a constant stream of ‘repriced’ reimbursement demands, it is practically impossible for health-care providers to meaningfully negotiate or pursue dispute resolution with respect to individual claims,” the lawsuit said. “Accordingly, any ‘negotiation’ with MultiPlan starts from the position of MultiPlan’s collusive offer to radically underpay health-care providers for their services and invariably ends with MultiPlan forcing the health-care provider to capitulate to an extreme underpayment.”

The lawsuit follows similar litigation filed last year by AdventHealth and just a few weeks ago by Allegiance Health Management. Although the CHS lawsuit does not name major health insurers as codefendants, CVS Health’s Aetna, Elevance Health, Centene Corp., Cigna, Health Care Service Corp., UnitedHealth Group and Humana are highlighted as coconspirators in the “MultiPlan cartel.”

CHS alleged that MultiPlan and the payers’ “blatantly illegal” conduct has led the health system to suffer damages totaling hundreds of millions of dollars, for which it is seeking repayments through the court. MultiPlan enlists the other payers to contribute their claims data to its tools, which then gives the company an advantage when repricing provider claims for out-of-network services, according to the lawsuit. MultiPlan also claims a portion of the “suppressed” reimbursement for itself, it added.

MultiPlan held such agreements with “nearly every other significant health-care insurance payer” by 2017, allowing its “spectacularly successful” strategy to flourish and pay 370,000 out-of-network claims per day by 2020, according to CHS. As a result of the “ongoing cartel agreement” with companies that its other service lines simultaneously compete with, the company pulls about $19 billion in reduced payments away from health-care providers each year, CHS wrote in its complaint. CHS cited “overwhelming direct evidence” of MultiPlan’s agreements with other payers, including Securities and Exchange Commission filings, sworn trial testimonies from payer organization heads and communications sent to providers.

MultiPlan disputes the allegations.

Related: A ‘cartel’ for insurers? AdventHealth sues MultiPlan over price fixing?

“We believe this lawsuit has no merit, and we look forward to disproving these baseless allegations,” a MultiPlan spokesperson told Becker’s Hospital Review. “MultiPlan plays a vital role in helping to reduce health-care costs across the entire health-care ecosystem, benefiting payors, providers, employers and patients.”