AMA Latest to Join Physician Suits Against MultiPlan

Physician anger at the data analytics firm MultiPlan is intensifying, with the American Medical Association (AMA) being the latest to sue the data analytics company over inadequate payments.

MultiPlan helps insurers to “identify and negotiate fair reimbursements for out-of-network claims,” among other services, according to its website. But multiple lawsuits allege the company has colluded with its insurer clients to enrich itself and the insurers at the expense of physicians.

In the AMA lawsuit, which was filed in the Northern District of Illinois and joined by the Illinois State Medical Society (ISMS), the organizations call MultiPlan “a far-reaching and unlawful cartel involving the nation’s largest health insurers.” 

MultiPlan is orchestrating “a horizontal, multilateral price-fixing scheme” that “depresses payments for out-of-network care,” stated the AMA and ISMS. The result: MultiPlan has quashed all competition for out-of-network services, said the suit.

MultiPlan claims on its website that it works with more than 700 payers (including Medicare Advantage, Medicaid, and Children’s Health Insurance Program plans), 100,000 employers covering 60 million lives, and 1.4 million contracted providers. Its clients include some of the largest insurers in the United States, and it claims to reduce out-of-network payments by $15 billion a year for those commercial clients.

“The payors, their investors, and their executives profit from money that should have rightfully been paid to doctors providing necessary medical care,” said AMA President Bruce A. Scott, MD, in a statement.

MultiPlan’s work has resulted in below-market reimbursement rates paid to physicians for out-of-network healthcare services, said ISMS President Piyush I. Vyas, MD, in the AMA statement.

The lawsuit alleges that MultiPlan receives a fee from an insurer based on a percentage of the difference between the initial claim amount and what the insurer pays.

A New York Times investigation published in 2024 showed that MultiPlan and insurers both made more money when MultiPlan ratcheted down fees paid to physicians for out-of-network services. The AMA and ISMS cited the investigation in its lawsuit, stating that its members were not aware of the extent of MultiPlan’s practices until the publication of the article.

The revenues generated by MultiPlan from its repricing services have increased from $23 million in 2012 to $564 million in 2020 and $709 million in 2021, according to the AMA.

The lawsuit seeks to end MultiPlan’s practices, calling them anticompetitive and fraudulent.

MultiPlan has defeated similar lawsuits before. In 2020, two provider-initiated class actions and two patient-initiated class actions, along with nine individual suits filed by behavioral health providers were all dismissed, according to the company.

More recently, however, six lawsuits have been consolidated into a class action that will be based in Northern Illinois — the same jurisdiction where the AMA and ISMS filed suit.

One of the suits in the consolidation was filed by the publicly-traded, Franklin, Tennessee–based Community Health Systems (CHS), which owns or leases 69 hospitals with more than 11,000 beds and operates more than 1000 care sites, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers, and ambulatory surgery centers.

In its suit, it also called MultiPlan part of a cartel.

US Senators Ron Wyden (D-Oregon) and Bernie Sanders (I-Vermont) requested more information from MultiPlan in May, stating they were concerned that the company might be driving up costs for consumers. Senator Amy Klobuchar (D-Minnesota) wrote to the Federal Trade Commission in May, seeking an investigation into what she called “potentially anticompetitive conduct.”

MultiPlan recently reported a slight decline in quarterly earnings, down to $233 million from $238 million in the second quarter in 2023. It also lowered its estimated revenues for 2024 from $1 billion to $935-955 million.

Alicia Ault is a St. Petersburg, Florida–based freelance journalist whose work has appeared in publications such as JAMA and Smithsonian.com. You can find her on X @aliciaault.