CHS sues MultiPlan

Franklin, Tenn.-based Community Health Systems is the latest health system to sue MultiPlan over allegations the data analytics firm conspired with major payers to underpay providers by tens of billions annually.

The lawsuit, filed May 8 in New York federal court, is the third from a health system in less than a year accusing MultiPlan of price fixing. Altamonte Springs, Fla.-based AdventHealth filed a lawsuit in August and Shreveport, La.-based Allegiance Health Management filed a lawsuit in April.   

The for-profit health system alleges that by 2017, MultiPlan reached agreements with nearly every other significant payer to use its repricing tools to collectively suppress out-of-network reimbursements paid to healthcare providers. 

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

CHS alleged the money MultiPlan and other payers withhold from providers "does not go to patients; it goes to insurance companies, their investors, and their executives." 

"MultiPlan has created, and continues to orchestrate, an ongoing cartel agreement with competing health insurance companies throughout the United States to bilk healthcare providers out of billions of dollars per year," CHS' lawsuit alleges. 

A MultiPlan spokesperson told Becker's, "we believe this lawsuit has no merit, and we look forward to disproving these baseless allegations."

"MultiPlan plays a vital role in helping to reduce healthcare costs across the entire healthcare ecosystem, benefiting payors, providers, employers, and patients," the spokesperson said. 

Aetna, Elevance, Centene, Cigna, Health Care Service Corp., UnitedHealth, and Humana are named as "co-conspirators" in the lawsuit, but are not listed as defendants. 

The lawsuit comes after The New York Times reported April 7 that major insurers made millions in fees by using MultiPlan to determine how much to pay providers for out-of-network claims. Minnesota Sen. Amy Klobuchar has also called on the Justice Department and the Federal Trade Commission to investigate potentially anticompetitive conduct by MultiPlan. 

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