Arizona Attorney General Kris Mayes has launched a lawsuit against MultiPlan and several of the nation’s largest health insurance companies, alleging they participated in an unlawful scheme that reduced payments to doctors and hospitals through the use of a common pricing algorithm.
The complaint, filed Monday in Maricopa County Superior Court, names MultiPlan along with major insurers including Aetna, Cigna, UnitedHealthcare, Humana, Elevance Health, Molina Healthcare, Centene Corporation and Health Care Service Corporation.
According to the lawsuit, the insurers allegedly shared confidential reimbursement data with MultiPlan, a healthcare billing technology company. The state contends that MultiPlan used the information to generate payment recommendations that resulted in similarly reduced reimbursement rates across competing insurers, particularly for out-of-network medical services.
Mayes described the alleged conduct as a modern form of price-fixing, arguing that technology was used to coordinate reimbursement decisions that should have been made independently by competing companies.
The attorney general is seeking a court order to halt the practice, require restitution to affected patients, healthcare providers and employers, and recover profits allegedly generated through the arrangement. The lawsuit also seeks civil penalties against the defendants.
The state’s action follows broader scrutiny of MultiPlan and the insurance industry. Similar allegations are at the center of a federal antitrust case involving the Arizona Medical Association, the American Medical Association and hundreds of physician groups nationwide. Those plaintiffs likewise claim the companies collaborated to suppress reimbursement rates through algorithm-driven pricing recommendations.
Federal regulators and lawmakers have also examined the issue in recent years, with congressional committees and the U.S. Department of Justice reportedly reviewing allegations involving algorithmic pricing practices in the healthcare sector.
MultiPlan, whose parent company recently adopted the name Claritev, processes hundreds of millions of medical claims annually. According to the attorney general’s complaint, the company and its insurer partners account for a significant majority of out-of-network commercial healthcare payments nationwide.
The case is expected to add to the growing national debate over the role of algorithms and data-sharing practices in setting healthcare costs and reimbursement rates.
