Overview
- The Arizona attorney general filed a lawsuit in Maricopa County on Monday, June 1, accusing MultiPlan (now Claritev) and eight large insurers of running a coordinated scheme to set low out‑of‑network reimbursement rates.
- Prosecutors say the companies shared competitively sensitive claims data through MultiPlan and used tools such as PlanOptix and a proprietary algorithm to benchmark and reprice payments across payers.
- The complaint alleges MultiPlan earned fees tied to the size of the underpayments and cites a claimed $6.4 billion in insurer savings in Q3 2024 as an example of the system’s financial impact.
- The suit says the repricing harmed PPO members by increasing out‑of‑pocket costs and squeezed independent and rural providers who could not absorb the lower payments.
- Defendants have denied wrongdoing and said they will defend themselves, while the case adds state enforcement to earlier media reporting, federal subpoenas, and related litigation and seeks injunctions, disgorgement and civil penalties that could reshape how out‑of‑network pricing is set.