ama files antitrust lawsuit against multplan for price fixing practices

The American Medical Association (AMA) and the Illinois State Medical Society have filed an antitrust lawsuit against MultiPlan, a healthcare data analytics firm.

Allegations of Anti-Competitive Practices

The lawsuit alleges that MultiPlan engages in practices that undermine market competition and facilitate price-fixing among major health insurers. It claims that MultiPlan coerces physicians into accepting low reimbursement rates for out-of-network medical services, leading to negative consequences for medical practices.

MultiPlan's revenue from repricing out-of-network payments has significantly increased over the years. Healthcare providers argue that these practices harm their financial viability and burden patients with high medical bills.

Accusations of Confidential Information Sharing

The lawsuit also accuses MultiPlan of serving as a conduit for insurers to share confidential information and suppress reimbursement rates. MultiPlan has faced legal challenges and industry backlash, with hospital and provider lobbies opposing its practices.

Previous Lawsuit and Historical Background

The AMA has previously joined a class-action lawsuit against Cigna, alleging underpaid claims within the MultiPlan network. The historical backdrop of these issues includes settlements with major insurers in 2009, which led to the establishment of FAIR Health.

Implications for Healthcare Reimbursement

The current lawsuit against MultiPlan highlights the ongoing tension between healthcare providers and insurers and the need for greater transparency and fairness in reimbursement practices. The outcome of this lawsuit could have significant implications for the healthcare reimbursement landscape in the United States.

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