The MultiPlan MDL: What does it all mean and where it's headed next?

The MultiPlan MDL alleges violations of Section 1 of the Sherman Act, 15 U.S.C. §1, including horizontal and hub-and-spoke agreements in restraint of trade, and anticompetitive information exchange. Out-of-network providers have previously sought to use antitrust law to challenge insurer reimbursements, but the MultiPlan MDL plaintiffs have attempted to distinguish their case from those that came before.

This article will look at the prior cases claiming similar violations, the current state of the MultiPlan MDL, and what the industry can expect next.

No antitrust injury found in prior rulings on out-of-network rate setting

The Sherman Act is a federal antitrust law that outlaws trusts, monopolies and cartels from controlling prices in a particular market. Historically, out-of-network provider plaintiffs have struggled to overcome challenges to standing in antitrust claims regarding reimbursement rates because “[a]s a general matter, the class of plaintiffs capable of satisfying the antitrust-injury requirement is limited to consumers and competitors in the restrained market, and to those whose injuries are the means by which the defendants seek to achieve their anticompetitive ends.” W. Penn Allegheny Health Sys., Inc. v. UPMC, 627 F.3d 85 (3d Cir. 2010).

In 2012, the USDC for the Central District of California found plaintiff providers lacked standing when they claimed injury related to insurers’ alleged failure to provide proper usual, customary, and reasonable (UCR) reimbursement rates for out-of-network providers on the basis that “[i]t is the Insurer Conspirators who are consumers in the data market, not the Subscriber Plaintiffs.” In re WellPoint, Inc. Out-of-Network UCR Rates Litig., 903 F. Supp. 2d 880 (C.D. Cal. 2012). In WellPoint, the court concluded that patients were the direct victims of an alleged third-party payor price-fixing agreement and the providers’ were only injured if the patients failed to pay the amount remaining due after a third-party payor’s alleged underpayment.

In Franco v. Connecticut General Life Insurance Company, the USDC for the District of New Jersey considered claims that various health insurers “engaged in price fixing when they agreed with their Conspirators to utilize precisely the same flawed database to determine the UCR amounts for out-of-network medical services, which lead to them paying substantially the same reduced amounts for services rendered to their subscribers.” 818 F. Supp. 2d 792 (D.N.J. 2011), aff'd in part, vacated in part, remanded, 647 F. App’x 76 (3d Cir. 2016). The Franco court concluded that the plaintiffs’ antitrust claim was implausible because there was no indication in the complaint that coverage for out-of-network services “is a distinct product available for purchase and sale apart from the rest of a subscriber's insurance policy, at its own price” and holding that “[p]roviding a product that is allegedly worth less to the insureds than the premium they paid does not equate with fixing, pegging or otherwise standardizing the price, or a component thereof, charged to insureds for the insurance coverage.”

Just this year, in Long Island Anesthesiologists PLLC v. United Healthcare Ins. Co. of New York Inc., the USDC for the Eastern District of New York considered Long Island Anesthesiologists’ claims that MultiPlan and United Healthcare conspired to “us[e] data-driven negotiation and/or reference-based pricing methodologies” to “reduce out-of-network reimbursement rates.” (E.D.N.Y. Apr. 7, 2025). LIA alleged violations of the Sherman Act and New York’s comparable Donnelly Act; allegations based on MultiPlan and United Healthcare’s use of data-driven negotiation practices to reduce reimbursement rates for out-of-network providers. The Eastern District of NY concluded that “without a plausible allegation of conspiracy or ‘something more,’ a “health plan lowering reimbursement rates paid to a physician practice is generally insufficient to establish antitrust injury,” as “lowering reimbursement rates to out-of-network providers is neither inherently unlawful nor anticompetitive under the antitrust laws.”.

In his April 7, 2025 opinion dismissing the antitrust claim, Judge Hector Gonzalez said LIA alleged the defendants engaged in an antitrust conspiracy, holding monopsony power, and engaging in anticompetitive conduct based on MultiPlan and United Healthcare’s data-driven negotiation practices to reduce reimbursement rates, but found LIA did not suffer an antitrust injury under the Sherman Act, because it did not allege that it was excluded from the health care market, as it could still provide out-of-network services or negotiate in-network participation. Rather, Judge Gonzalez said LIA was really complaining about a reduction in its reimbursement rates, which made its practice less profitable, conduct that is neither unlawful nor anticompetitive, stating LIA had to show “something more” in addition to the reduced reimbursement rates, to have a claim. This decision has been appealed to the US Court of Appeals for the Second Circuit.

MultiPlan MDL’s motion to dismiss declined: What the ruling says about discovery

On June 3, 2025, USDC Judge Matthew F. Kennelly issued a ruling on the defendants’ motion to dismiss in the MultiPlan MDL in which he declined to dismiss the plaintiffs’ antitrust claims. (He also declined to dismiss the consumer protection claims but granted the dismissal as to the unjust enrichment claims.) The case will now proceed to discovery and the ruling pointed to several factual issues that preview the shape discovery is likely to take.

During discovery, plaintiffs will seek to prove they suffered an antitrust injury. MultiPlan MDL plaintiffs seek to distinguish their case from cases like WellPoint by alleging that they do not have the ability to bill patients for the difference between the amount charged and the amount paid (“balance bill”) because MultiPlan conditions its offer of payment on an agreement not to balance bill and the risk of not receiving any payment if MultiPlan’s offer is declined is too significant to overcome. In his ruling, Judge Kennelly found, [b]ecause the alleged balance billing prohibition prevents providers from seeking the remaining payment from patients and shields patients from the consequences of the alleged third-party payor price-fixing agreement, the providers have alleged a direct [antitrust] injury.”

Another issue for discovery will be whether the market for out-of-network health care services for purchase by third-party commercial payers is a relevant market under the Sherman Act. In the ruling, Judge Kennelly stated, “[t]o be clear, the Court is not finding that the defendants' critiques of the relevant market are baseless. The defendants raise fair concerns regarding the scope and type of services covered by the plaintiffs' alleged nationwide market for out-of-network health care services. But the bulk of these criticisms amount to factually disputing the plaintiffs' allegations, which are disputes the Court may not resolve at this stage of review.”

Finally, discovery will be extensive as to whether the relationship between MultiPlan and the codefendants constitutes an illegal agreement in violation of the Sherman Act. In the motion to dismiss, the defendants argued that even if providers are getting below-market payments, the plaintiffs fail to allege the lesser payments are due to a harm to competition; rather, MultiPlan actually increases competition by providing another rate-calculation option and lowers costs to third-party payors and their subscribers. On this, Judge Kennelly ruled that “[w]hether MultiPlan facilitates a third-party payor price-fixing agreement or is simply another pricing option for payors is… a factual dispute that cannot be resolved on a motion to dismiss.”

Disputes about compensation methods for out-of-network providers have plagued the managed care industry for decades. The recent developments discussed here suggest that the question about whether this should be litigated in an antitrust context is fact-specific and will persist as a focus for years to come. Whether SCOTUS will have an opportunity to review lower court decisions is yet to be determined, but given the recent developments, the likelihood is ever increasing.

Christopher J. Tellner is a partner at Kaufman Dolowich, based in Philadelphia, Penn., and co-chair of the firm’s Health Care & Managed Care Practice Group. He specializes in professional liability defense, including the defense of health care facilities and practitioners. Prior to entering the legal profession, he worked as a health care professional. He may be reached at ctellner@kaufmandolowich.com.

Stacey Widlansky is Sr. Vice President of Chatham Insurance Services based in Connecticut. Chatham is the largest Managing General Underwriter exclusively serving the Managed Care Industry, underwriting E&O, D&O, EPL, Fiduciary, Cyber and Crime. Prior to joining Chatham, Stacey spent fifteen years in various Claims roles at Allied World. She may be reached at stacey.widlansky@chathamins.com.