IN RE: Multiplan Health Insurance Provider Litigation
1:24-cv-06795
N.D. Ill.Jun 3, 2025Background
- Healthcare providers (plaintiffs) sued MultiPlan, Inc. and major insurers (including Aetna, Cigna, UnitedHealth, Blue Cross Blue Shield, and others) alleging a conspiracy to fix payments for out-of-network healthcare services.
- The case encompasses both a consolidated class action (federal antitrust only) and a consolidated direct action (federal/state antitrust, consumer protection, and unjust enrichment claims).
- Plaintiffs allege defendants shifted from independent usual, customary, and reasonable (UCR) benchmarks (previously governed by FAIR Health after state settlements) to MultiPlan’s Data iSight algorithm, which supposedly led to suppressed, below-market compensation and eliminated real negotiation.
- Plaintiffs claim MultiPlan’s algorithm facilitated price alignment among payors and effectively suppressed competition in the market for out-of-network health services.
- Defendants moved to dismiss, attacking standing, antitrust injury, the definition of the relevant market, and the plausibility of an antitrust agreement, as well as non-antitrust claims.
- This opinion arises at the motion to dismiss stage; all well-pled allegations are taken as true.
Issues
| Issue | Plaintiff’s Argument | Defendant’s Argument | Held |
|---|---|---|---|
| Antitrust standing and injury | Providers are directly injured because MultiPlan restricts balance billing, so they cannot recoup underpayments. | Providers can seek full payment from patients, so only indirect injury if patients don’t pay. | Providers plausibly alleged direct injury and standing. |
| Antitrust injury | Defendants’ conduct suppressed out-of-network compensation via a price-fixing scheme, harming competition. | MultiPlan increased competition; plaintiffs only allege economic loss or seek inflated former benchmarks. | Plaintiffs plausibly alleged antitrust injury. |
| Relevant market | Out-of-network healthcare payments to payors constitute a distinct nationwide cluster market. | Market definition is overbroad; no fixable price; must include in-network services; market not nationwide. | Plaintiffs plausibly alleged a relevant market. |
| Agreement/conspiracy plausibility | MultiPlan facilitated a hub-and-spokes horizontal agreement among payors, using aligned algorithms and info-sharing. | Only vertical contracts with MultiPlan; no direct evidence of agreement among payors; conduct is rational. | Sufficient facts pled for a plausible hub-and-spokes agreement. |
| State claims (antitrust/consumer) | State antitrust claims parallel federal; consumer claims allege harm to patient access/choice. | State claims fail if federal fail; consumer harms not plausibly alleged, or not pled with needed specificity. | State antitrust/consumer claims plausibly alleged. |
| Unjust enrichment | Theory applies nationwide; all states' laws are materially the same. | State unjust enrichment law varies; complaint lacks facts by state/law. | Unjust enrichment claims dismissed for insufficient pleading. |
Key Cases Cited
- Ashcroft v. Iqbal, 556 U.S. 662 (plausibility standard for motions to dismiss)
- Bell Atl. Corp. v. Twombly, 550 U.S. 544 (pleading standard for antitrust complaints)
- United States v. Socony-Vacuum Oil Co., 310 U.S. 150 (price fixing is per se illegal under Sherman Act)
- United States v. Masonite Corp., 316 U.S. 265 (hub-and-spokes conspiracy can establish horizontal agreement)
- Brown Shoe Co. v. United States, 370 U.S. 294 (relevant market analysis under antitrust law)
- E.I. du Pont de Nemours & Co., 351 U.S. 377 (relevant market defined by interchangeability)
- Atl. Richfield Co. v. USA Petrol. Co., 495 U.S. 328 (antitrust injury requires competitive harm)
- Leegin Creative Leather Prods., Inc. v. PSKS, Inc., 551 U.S. 877 (distinction between per se and rule of reason analysis)