An Illinois federal judge has largely rejected MultiPlan’s motion to dismiss multidistrict litigation (MDL) accusing the healthcare data firm of illegally fixing out-of-network reimbursement rates. The ruling trims only unjust enrichment claims while allowing key antitrust claims to move forward, marking a significant development in the ongoing MultiPlan Reimbursement Pricing Antitrust MDL.

MultiPlan, known for its pricing tools used by insurers including Aetna and UnitedHealth Group, sought to dismiss consolidated class action and direct-action complaints earlier this year. However, the court found sufficient allegations that MultiPlan and its co-defendants colluded to systematically underpay out-of-network providers through coordinated pricing practices.

The MDL complaints assert that MultiPlan’s algorithms and pricing strategies force providers to accept below-market reimbursement rates, backed by balance-billing prohibitions that effectively block providers from recovering full payment from patients. U.S. District Judge Matthew Kennelly noted that providers accept MultiPlan’s initial offers over 95% of the time, indicating the practical impact of the alleged scheme.

Judge Kennelly emphasized that the system shields patients from direct harm, leaving providers as the primary parties with incentives to enforce antitrust laws. He rejected defendants’ claims that providers suffered no direct injury, affirming that plaintiffs have plausibly alleged harm through “unreasonably low compensation amounts” facilitated by MultiPlan’s dominant market position.

The court also found that the plaintiffs sufficiently defined the relevant market as out-of-network healthcare services paid by third-party payors and alleged a plausible horizontal price-fixing agreement among MultiPlan’s 700+ third-party payor clients. The judge highlighted statements by MultiPlan indicating its capability to “align” reimbursement rates across clients through sharing competitively sensitive pricing information.

While the court dismissed unjust enrichment claims brought by direct-action plaintiffs for failure to address differing state laws, it allowed state consumer protection claims to proceed in multiple jurisdictions, including Arizona, California, Colorado, Connecticut, Minnesota, New Mexico, North Carolina, South Carolina, and Tennessee.

Attorneys representing the direct-action plaintiffs praised the ruling, stating, “MultiPlan and its co-conspirators orchestrated a cartel to illicitly coordinate out-of-network reimbursements, devastating medical practices and siphoning billions from the healthcare system.” They affirmed that the court’s decision clears the way for discovery and further legal challenges.

The MDL class plaintiffs are represented by Edelson PC, Susman Godfrey LLP, and Berger Montague PC. Direct-action plaintiffs’ counsel includes Arnall Golden Gregory LLP, Seeger Weiss LLP, Napoli Shkolnik PLLC, and Vinson & Elkins LLP. MultiPlan is represented by Latham & Watkins LLP and Phelps Dunbar LLP.

The case, In re: MultiPlan Health Insurance Provider Litigation, case number 1:24-cv-06795, is pending in the U.S. District Court for the Northern District of Illinois.