This article was submitted by TMA's legal department. For questions, reach out to legal@tnmed.org.

The American Medical Association (AMA), medical societies in Illinois, California, and elsewhere, and individual physicians sued the discount network giant, MultiPlan, in 2024 alleging it engaged in anticompetitive antitrust activity designed to fix out-of-network physician reimbursement rates at below market levels. The lawsuit alleges that MultiPlan is at the center of a price-fixing conspiracy with the large commercial health insurance companies that has undercut fair payment for out-of-network health care services and eliminated market competition resulting in harm to patients and physicians.

Physicians and other health care providers around the country can join the lawsuit if they believe they have been underpaid by big health insurance companies like Aetna, Cigna, UnitedHealthcare, and BlueCross BlueShield for out-of-network services. According to the AMA, for each claim it reprices, MultiPlan receives a fee from the health insurer based on a percentage of the difference between the filed claim amount and what the insurer actually pays the doctor for out-of-network services.

Many physicians feel like they have been underpaid by health insurance companies for out-of-network services. Problem is, it is not easy to tell if it happened, or to what extent. The linked flyer explains some ways to check, include reviewing EOBs and remittance advices to determine if MultiPlan’s name appears on these documents. According to the flyer, common references on these documents include “MultiPlan,” “Data iSight,” “Viant,” “NCN” (National Care Network), “ProPricer,” or “MARS”— which are affiliated pricing tools and networks.

The allegations in the lawsuit go back to 2015. Since the theory of recovery is that these health insurance entities violated the Sherman Antitrust Act, if doctors prevail, they are entitled to three times (treble) the damages awarded. Physicians considering joining the lawsuit may be eligible for contingent-fee legal representation, meaning the lawyers are only paid if the plaintiffs win the case. For a free evaluation of your case, go to napolilaw.com/en/multiplan/.

While the physician plaintiffs are seeking monetary damages, the AMA and the other medical associations are seeking injunctive and declaratory relief to stop the alleged conduct by MultiPlan and the health insurers going forward.