MultiPlan's website. Credit: Monika Kozak/ALM
A company that manages health care provider networks is blasting providers who have accused it of antitrust law violations in connection with determining what plans should pay for out-of-network care.
The company, MultiPlan, contends that the providers have provided no evidence of any kind of price-fixing or other wrongdoing, and it says it uses publicly available data sets to develop recommendations for out-of-network provider reimbursement levels.
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"The benchmarks MultiPlan uses dramatically lower financial exposure for consumers," the company says. "Plaintiffs instead want the Court to require the use of their preferred benchmarks, which they concede lead to higher prices that they can recover from patients and health plans. It is Plaintiffs — not Defendants — who are harming consumers."
The plaintiffs do not make any plausible argument that the reimbursement rate calculation they like, the "usual, customary and reasonable" rate methodology, is based on competitive, market rates, MultiPlan says.
MultiPlan made those arguments in a motion to dismiss filed in connection with the In Re: MultiPlan Health Insurance Provider Litigation.
The federal courts created the multidistrict litigation process, which is under the jurisdiction of a judge in the U.S. District Court for the U.S. District of Illinois, to consolidate pretrial proceedings for a barrage of antitrust suits naming MultiPlan as the defendant.
Related: Panel consolidates Health Care Providers v. Payers in Illinois
The new MultiPlan motion applies to suits filed by individual health care providers and provider organizations, outside the scope of the many class-action lawsuits filed against MultiPlan.
Health care providers have had success with getting sympathy from state legislators and members of Congress in recent years.
In June, for example, Sen. Ron Wyden, D-Ore., and Sen. Bernie Sanders, an independent who caucuses with the Democrats, complained about MultiPlan recommending "crazy low" prices for out-of-network care.
Executives at health insurers and health care cost management companies contend that they are under attack because of their work to narrow other health care system players' profit margins.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
