Latest news with #MultiPlan
Medscape
2 days ago
- Business
- Medscape
Judge Allows Docs' Lawsuit Against MultiPlan to Proceed
A district judge has ruled that physicians can move forward with a federal lawsuit that accuses insurers and an analytics company of underpaying them by billions through a price-fixing scheme for out-of-network services. In a June 3 decision, US District Judge Matthew Kennelly wrote that providers have alleged a direct injury from the reported price-fixing agreement and that their antitrust claims against data company MultiPlan are valid. The ruling addresses two consolidated complaints by several plaintiffs, including the American Medical Association (AMA) and the Illinois State Medical Society (ISMS), against MultiPlan, which has now changed its name to Claritev. The medical associations claim MultiPlan/Claritev and third-party payers violated federal and state antitrust laws with a price-fixing conspiracy that forced physicians to accept increasingly low payments for out-of-network services. The suit names Aetna, Cigna, UnitedHealth Group, and Health Care Service Corporation, a Mutual Legal Reserve Company, as 'co-conspirators' in the complaint, among other 'smaller' insurers. AMA President Bruce A. Scott, MD, praised the court for allowing the case to proceed, calling the ruling 'the clearest statement yet by a court that MultiPlan's lack of transparency, accuracy, and integrity in the insurer-run system for paying out-of-network medical bills is an antitrust violation.' 'MultiPlan and the commercial health insurance companies have profited from the rigged system while forcing physicians to accept lower and lower payment amounts for out-of-network services — payments that in many cases do not cover the cost of delivering care to patients,' Scott said in a media statement. 'Ending this conspiracy is a good start toward creating an open and honest system that will restore fair reimbursements and help ensure patients have access to the care they need.' A Claritev spokeswoman told Medscape Medical News in an email that the company remains 'confident that the facts will reinforce what we've consistently said — that these lawsuits are without merit and fail to acknowledge the critical role our competitive options play in reducing healthcare costs for employers and improving access for patients.' 'These lawsuits will only serve to increase healthcare [costs] for employers and patients. We will vigorously defend ourselves through the legal process while remaining focused on delivering value to our customers and the broader healthcare ecosystem.' ISMS President Richard C. Anderson, MD, said the medical society appreciates the ruling and that it's 'time for MultiPlan to face the music.' 'The company can change its name, but it doesn't change the fact that they reaped huge profits from this price-fixing collusion,' Anderson wrote in an email to Medscape Medical News . 'They routinely paid below-market reimbursement rates to physician for out-of-network healthcare services with no transparency in their process. Patients and physicians deserve better.' Alleged Price-Fixing Conspiracy On its website, Claritev describes itself as a healthcare technology, data, and insights company that focuses on improving affordability, transparency, and quality. The company offers an alternative method for calculating a third-party payer's out-of-network rate through its Data iSight algorithm, according to court records. Data iSight calculates rates by referencing the cost of the service to the provider and the median payment for similar services rendered, according to the legal summary. Using these metrics, the algorithm tends to produce lower payment rates than Usual, Customary, and Reasonable benchmarks. If payers agree to use a Data iSight-calculated rate, the company offers to negotiate the rate with providers on behalf of the insurer. During the negotiation, MultiPlan/Claritev conditions all payments on a provider's agreement not to balance bill the patient, according to the legal summary. The plaintiffs allege the company's rates are provided on a 'take-it-or-leave-it' basis and that they were unable to convince the company to deviate from a Data iSight-calculated rate. Providers can still decline MultiPlan's offer and seek payment directly from the patient and the insurer, according to court documents. An April 2020 study by the Office of the New York State Comptroller found that payments based on MultiPlan's repricing methodology at the time were 1.5-49 times lower than payments for the same services based on the traditional method of calculating out-of-network payment rates for physicians, according to the AMA. The physician plaintiffs contend the company undercuts fair payment for out-of-network healthcare services and eliminates market competition. The 'widespread conspiracy' between the company and insurers has forced many medical practices to shut down, cease offering certain services, or seek other employment arrangements, according to their complaint. Insurers have contracted with MultiPlan to use its Data iSight algorithm and negotiation services since 2015, and by 2018, hundreds of third-party payers had contracts with the company, according to court records. The company grew to having contracts with more than 700 third-party payers and, in 2019, processed more than 80% of out-of-network healthcare service payments, according to court documents. A 2024 New York Times investigation found that both the company and insurers made more money when then-MultiPlan lowered fees paid to physicians for out-of-network services. In May 2024, Ron Wyden (D-Oregon) and Bernie Sanders (I-Vermont), US senators, requested more information from MultiPlan, expressing concern that the company might be driving up costs for consumers. Sen. Amy Klobuchar (D-Minnesota) also sent a letter to the Federal Trade Commission in May 2024, seeking an investigation into what she deemed 'potentially anticompetitive conduct.' Company Argues Claims Invalid MultiPlan/Claritev asked the court to throw out the complaint, arguing the plaintiffs have not asserted a viable federal antitrust claim because they have not proven antitrust standing nor shown how the company violated antitrust law. Even if the providers are getting below-market payments, the company said the doctors have failed to allege the lesser payments are due to a harm to competition. Rather, MultiPlan/Claritev's services increase competition by providing another rate calculation option, and its services are further beneficial because they lower costs to third-party payers and patients, the company's attorneys argued. In addition, the company contended that providers have not been directly injured by the alleged party payer agreement to fix prices because 'they can always seek full payment from the patient.' However, Kennelly wrote that the providers have alleged a direct injury because 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.' If MultiPlan/Claritev's services are harmful or beneficial to competition is a matter for further court analysis, Kennelly also said. 'Whether 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,' he wrote in his ruling. The judge, however, dismissed the plaintiffs' unjust enrichment claims against the company. Kennelly wrote the physicians failed to allege an unjust enrichment claim under a specific state law. A case management conference in the case is scheduled for June 17.
Reuters
03-06-2025
- Business
- Reuters
US judge rules health insurers, MultiPlan must face price-fixing lawsuits
June 3 (Reuters) - A U.S. judge on Tuesday said healthcare providers can pursue claims that technology provider MultiPlan and a group of insurers conspired to underpay them billions of dollars in reimbursements for out-of-network health services. U.S. District Judge Matthew Kennelly in Chicago ruled, opens new tab that doctors and other providers who filed the proposed class action had plausibly alleged a price-fixing conspiracy that relied on insurers collectively sharing sensitive information with MultiPlan to set reimbursement rates. MultiPlan, which rebranded as Claritev in February, processes payments for out-of-network healthcare services. Major insurers, including defendants UnitedHealth, Aetna and Cigna, have contracts with the company and use its software. In a statement on Tuesday, MultiPlan said it was 'confident in the strength of our legal position' and that the lawsuits have no merit. Aetna parent CVS in a statement said, 'we stand ready to argue the substantive facts of the case and defend ourselves vigorously in this matter.' UnitedHealth and Cigna did not immediately respond to requests for comment. All of the defendants have denied any wrongdoing. Kennelly is presiding over consolidated, opens new tab lawsuits that were first filed in 2023. MultiPlan processes more than 80% of out-of-network claims across the country, or abut 370,000 daily claims, according to the plaintiffs. In a statement, attorneys for the health providers said MultiPlan and the insurance defendants 'orchestrated a cartel through the sharing of competitively sensitive confidential pricing information to illicitly coordinate on out-of-network reimbursements.' MultiPlan and the insurers have argued that health providers are free to reject an insurance company's payment and instead seek full compensation from patients. MultiPlan told the court its services provide industry more flexibility, lowering costs to insurers and patients. Kennelly in his ruling said "whether or not MultiPlan's calculated rates are labeled as 'recommendations,' the plaintiffs plausibly allege that they are more akin to mandates." The U.S. Justice Department submitted a court filing in March backing claims in the health providers' case. The case is In re MultiPlan Health Insurance Provider Litigation, U.S. District Court for the Northern District of Illinois, No. 1:24-cv-06795. Read more: US Justice Department backs medical providers' lawsuit over data analytics software Hospital sues data analytics company MultiPlan in US court antitrust case
Yahoo
09-04-2025
- Business
- Yahoo
Claritev Announces Sponsorship Agreement with Professional Golfer Neal Shipley
Rising professional golfer and Full Swing star Neal Shipley to showcase Claritev branding as he advances his career. MCLEAN, Va., April 09, 2025--(BUSINESS WIRE)--Claritev Corporation ("Claritev" or the "Company") (NYSE: CTEV), formerly known as MultiPlan, a technology, data and insights company focused on making healthcare more affordable, transparent and fair for all, today announced a sponsorship agreement with professional golfer Neal Shipley. As part of the sponsorship, Shipley will display the Claritev logo on his shirt collar while competing. Shipley, 24, turned professional in the summer of 2024 after an impressive amateur career. He made history as the low amateur at both the 2024 Masters Tournament and the 2024 U.S. Open, becoming only the ninth golfer in PGA TOUR history to achieve this distinction in both tournaments in the same year. Originally from Pittsburgh, Shipley is currently competing on the PGA TOUR Americas and has received sponsor exemptions to play in multiple PGA TOUR events. He played college golf at James Madison University before transferring to The Ohio State University. "We are thrilled to partner with Neal Shipley as he continues his ascension in his professional golf career," said Travis Dalton, Chairman, CEO and President of Claritev. "Neal's dedication and innovative approach aligns perfectly with two of Claritev's core values – pursuit of service excellence, and being bold and intentional. His journey from a standout amateur to a professional golfer is inspiring, and we are excited to support him." In addition to his accomplishments on the course, Shipley was also recently featured in the third season of Full Swing, the hit docuseries on Netflix that follows some of the biggest names in golf. Full Swing highlights Shipley's remarkable journey to the 2024 Masters and captures his experience playing alongside Tiger Woods in the final round of the tournament. "I am honored to partner with Claritev as I continue to advance my career," said Shipley. "Having the support of a company that plays a significant role in making healthcare more affordable, transparent and fair for all Americans means a lot to me, and I look forward to representing the company on and off the course." About Claritev Claritev, formerly known as MultiPlan, is a healthcare technology, data and insights company focused on delivering affordability, transparency and quality to the U.S. healthcare system. Led by a team of deeply experienced associates, data scientists and innovators, Claritev provides cutting-edge solutions and services fueled by over 40 years of claims processing data. Claritev leverages world-class technology and AI to power a robust enterprise platform that delivers meaningful insights to drive affordability and price transparency and optimizes networks and benefits design in healthcare. By developing purpose-built solutions that support all key stakeholders — including payors, employers, patients, providers and third parties — Claritev is dedicated to making healthcare more accessible and affordable for all. Claritev serves more than 700 healthcare payors, over 100,000 employers, 60 million consumers, and 1.4 million contracted providers. For more information, visit View source version on Contacts Media Relations Pamela WalkerVP, Marketing & CommunicationClaritev781-895-3118press@ Investor Relations Jason WongSVP, Treasury & Investor RelationsClaritev866-909-7427investor@ Shawna GasikAVP, Investor RelationsClaritev866-909-7427investor@ Sign in to access your portfolio
Reuters
27-03-2025
- Business
- Reuters
US Justice Dept backs medical providers' lawsuit over data analytics software
March 27 (Reuters) - The U.S. Justice Department has lined up to support medical providers in lawsuits against health insurers and a data analytics company, telling a U.S. judge that the use of a common pricing algorithm can violate federal antitrust law. In a court filing, opens new tab on Thursday, the Justice Department's antitrust division, under the leadership of newly confirmed Assistant Attorney General Gail Slater, challenged legal arguments made by analytics company MultiPlan and other defendants in their bid to dismiss a series of class action lawsuits. Healthcare providers last year alleged major health insurers commonly were using a MultiPlan software tool as part of a price-fixing conspiracy that underpaid the providers billions of dollars in reimbursement rates for out-of-network services. The lawsuits were consolidated before U.S. District Judge Matthew Kennelly. MultiPlan, which rebranded in February as Claritev, on Thursday declined to comment on the Justice Department's filing but said the lawsuits 'are without merit and would ultimately increase prices for patients and employers.' Other defendants also have denied any wrongdoing. Christopher Seeger of Seeger Weiss, a lead attorney for the plaintiffs, in a statement said the Justice Department's filing validates claims against MultiPlan and health insurer defendants. 'We look forward to holding the defendants accountable, ensuring that medical providers receive fair compensation and every American has access to the quality healthcare they deserve,' Seeger said. The Justice Department did not immediately respond to a request for comment. The medical providers' lawsuits came amid a growing number of cases claiming hotels and other industries unlawfully use revenue maximization platforms to fix prices. The insurer defendants have argued that there was no conspiracy because they did not use MultiPlan in the same way to determine individual reimbursements. The Justice Department was not a party in the medical providers' lawsuit, but asked to express the views of the United States. 'Competitors' use of algorithmic technologies to coordinate their decision-making poses a growing threat to the free market competition on which our economic system is premised,' Justice Department lawyers said in their filing. The case is In re MultiPlan Health Insurance Provider Litigation, U.S. District Court for the Northern District of Illinois, No. 1:24-cv-06795.
Yahoo
28-01-2025
- Business
- Yahoo
MultiPlan Corporation's (NYSE:MPLN) top owners are private equity firms with 41% stake, while 27% is held by institutions
MultiPlan's significant private equity firms ownership suggests that the key decisions are influenced by shareholders from the larger public A total of 4 investors have a majority stake in the company with 54% ownership Insiders have bought recently If you want to know who really controls MultiPlan Corporation (NYSE:MPLN), then you'll have to look at the makeup of its share registry. With 41% stake, private equity firms possess the maximum shares in the company. That is, the group stands to benefit the most if the stock rises (or lose the most if there is a downturn). Meanwhile, institutions make up 27% of the company's shareholders. Generally speaking, as a company grows, institutions will increase their ownership. Conversely, insiders often decrease their ownership over time. In the chart below, we zoom in on the different ownership groups of MultiPlan. See our latest analysis for MultiPlan Many institutions measure their performance against an index that approximates the local market. So they usually pay more attention to companies that are included in major indices. MultiPlan already has institutions on the share registry. Indeed, they own a respectable stake in the company. This implies the analysts working for those institutions have looked at the stock and they like it. But just like anyone else, they could be wrong. It is not uncommon to see a big share price drop if two large institutional investors try to sell out of a stock at the same time. So it is worth checking the past earnings trajectory of MultiPlan, (below). Of course, keep in mind that there are other factors to consider, too. Our data indicates that hedge funds own 5.5% of MultiPlan. That's interesting, because hedge funds can be quite active and activist. Many look for medium term catalysts that will drive the share price higher. Hellman & Friedman LLC is currently the company's largest shareholder with 33% of shares outstanding. With 7.9% and 7.7% of the shares outstanding respectively, Public Investment Fund and GIC Special Investments Pte. Ltd. are the second and third largest shareholders. To make our study more interesting, we found that the top 4 shareholders control more than half of the company which implies that this group has considerable sway over the company's decision-making. While studying institutional ownership for a company can add value to your research, it is also a good practice to research analyst recommendations to get a deeper understand of a stock's expected performance. While there is some analyst coverage, the company is probably not widely covered. So it could gain more attention, down the track. While the precise definition of an insider can be subjective, almost everyone considers board members to be insiders. Company management run the business, but the CEO will answer to the board, even if he or she is a member of it. Insider ownership is positive when it signals leadership are thinking like the true owners of the company. However, high insider ownership can also give immense power to a small group within the company. This can be negative in some circumstances. We can see that insiders own shares in MultiPlan Corporation. It has a market capitalization of just US$259m, and insiders have US$15m worth of shares, in their own names. It is good to see some investment by insiders, but it might be worth checking if those insiders have been buying. With a 13% ownership, the general public, mostly comprising of individual investors, have some degree of sway over MultiPlan. While this group can't necessarily call the shots, it can certainly have a real influence on how the company is run. With a stake of 41%, private equity firms could influence the MultiPlan board. Sometimes we see private equity stick around for the long term, but generally speaking they have a shorter investment horizon and -- as the name suggests -- don't invest in public companies much. After some time they may look to sell and redeploy capital elsewhere. While it is well worth considering the different groups that own a company, there are other factors that are even more important. Consider for instance, the ever-present spectre of investment risk. We've identified 2 warning signs with MultiPlan (at least 1 which is potentially serious) , and understanding them should be part of your investment process. If you would prefer discover what analysts are predicting in terms of future growth, do not miss this free report on analyst forecasts. NB: Figures in this article are calculated using data from the last twelve months, which refer to the 12-month period ending on the last date of the month the financial statement is dated. This may not be consistent with full year annual report figures. Have feedback on this article? Concerned about the content? Get in touch with us directly. Alternatively, email editorial-team (at) article by Simply Wall St is general in nature. We provide commentary based on historical data and analyst forecasts only using an unbiased methodology and our articles are not intended to be financial advice. It does not constitute a recommendation to buy or sell any stock, and does not take account of your objectives, or your financial situation. We aim to bring you long-term focused analysis driven by fundamental data. Note that our analysis may not factor in the latest price-sensitive company announcements or qualitative material. Simply Wall St has no position in any stocks mentioned. Sign in to access your portfolio
