A lawsuit has been filed in the Northern District of Illinois against MultiPlan, accusing the company of engaging in an unlawful price-fixing scheme that has impacted physicians since 2015. The lawsuit claims that this practice has forced doctors to accept lower payments for out-of-network services, often insufficient to cover operating costs. As a result, many medical practices have had to close or alter their services, reducing patient options.

"MultiPlan’s pricing scheme does not generate any savings for patients," stated AMA President Bruce A. Scott, M.D. He added that the health insurance costs continue to rise while profits benefit payors and executives at the expense of doctors providing necessary care. Dr. Scott criticized the system as dysfunctional and pointed out that MultiPlan profits from price fixing without regard for patients or legitimate healthcare costs.

An April 2020 study by the Office of the New York State Comptroller highlighted that payments based on MultiPlan's methodology were significantly lower than traditional methods for calculating out-of-network rates.

ISMS President Piyush I. Vyas, M.D., expressed strong support for the lawsuit, emphasizing that it addresses below-market reimbursement rates and lack of transparency in fee calculations. "This will ensure patients can afford the healthcare they deserve," he said.

The complaint highlights MultiPlan's economic interest in keeping payment rates low since it receives a fee from insurers based on savings generated through repricing claims. This revenue grew substantially from $23 million in 2012 to $709 million in 2021.

Dr. Scott noted that through this legal action, both AMA and ISMS aim to reform out-of-network payment systems used by commercial health insurers and end reliance on MultiPlan's practices.