Altamonte Springs, Fla.-based AdventHealth is suing MultiPlan for an alleged ongoing conspiracy among commercial health insurers to reduce the reimbursement rates they pay to providers for out-of-network services.
The health system alleges in the lawsuit filed in New York federal court that MultiPlan's horizontal repricing agreement with "virtually every other significant health insurance payer" has underpaid providers by $19 billion annually. Those payers include UnitedHealth, Health Care Service Corp., Cigna, Centene, Elevance and Aetna.
AdventHealth alleges that MultiPlan takes a cut of the money that the payers withhold from providers.
"MultiPlan knows it can get away with acting, in the words of an analyst, 'like a mafia enforcer for insurers,' because virtually every commercial healthcare payor has agreed to use its repricing methodology, leaving healthcare providers with no practical option but to accept the 'repriced' reimbursement amount that MultiPlan imposes," AdventHealth alleges in the lawsuit.
AdventHealth is seeking, among other things, for MultiPlan to pay damages for underpayments, lost profits, revenues and other economic harm as a result of the scheme in an amount to be determined at trial and that may be trebled by operation of law. It is also seeking an order permanently barring the company from operating the "MultiPlan Cartel."
MultiPlan told Becker's in a statement the company "believes this lawsuit has no merit and looks forward to disproving these baseless allegations."