Mega Doctor News
Texas Medical Association
The Texas Medical Association (TMA) has joined a federal multidistrict litigation against MultiPlan (recently rebranded to Claritev) and major insurers, including UnitedHealth, Elevance, Humana, Aetna, and Cigna, alleging they conspired to systematically underpay health care practitioners for reimbursements for out-of-network services, which often fail to even cover operating costs. MultiPlan goes by many names, including Data iSight, Viant, NCN, ProPricer, and MARS. Plaintiffs allege that MultiPlan facilitated a price-fixing agreement among insurers that artificially suppressed out-of-network payment rates and cost physicians and providers billions of dollars.
TMA joins the American Medical Association (AMA) and hundreds of physician practices and facilities nationwide in this growing antitrust litigation.
“For many years, physicians in Texas have been forced to accept increasingly insufficient reimbursements for providing health care to out-of-network patients,” said TMA President Jayesh “Jay” Shah, MD. “This lawsuit is an important step to ensure that physicians are justly reimbursed for the care they provide, not only today, but also for historical underpayments going back to at least 2015, and end this alleged illegal collusion that hurts patients.”
This lawsuit, filed in the Northern District Court of Illinois in 2024, seeks to end MultiPlan’s alleged anticompetitive scheme that it has operated since at least 2015, and recoup financial damages for practitioners and practices. As of 2024, MultiPlan processes more than 80% of all commercial out-of-network reimbursement claims in the United States. Physicians and providers may not always know whether MultiPlan, or one of its services like Data iSight, Viant, NCN, ProPricer, or MARS, re-priced their claims. Clues can often be found in Explanations of Benefits or remittance advice.
Physicians who believe they have been harmed by MultiPlan and the insurance companies, whether current or in past years, can obtain a free case evaluation from one of the attorneys appointed by the court to lead the non-class claims.
The court also has appointed attorneys to litigate a proposed antitrust class action on the same issues, but a ruling on any proposed class certification is not expected until 2027. Physicians and providers who believe they have been impacted by MultiPlan’s conduct can choose to pursue their claims individually on a non-class basis and do not need to wait for any ruling on a proposed class.
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About TMA
TMA is the largest state medical society in the nation, representing more than 60,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 has been to improve the health of all Texans.
About Court Appointed Council
Gilbert LLP
Gilbert LLP is a nationally recognized law firm specializing in complex dispute resolution, insurance recovery and risk management, strategic corporate counseling, bankruptcy and receiverships, and high‑stakes litigation. The firm delivers results through innovative legal strategies that integrate business insight and practical problem-solving. Clients include corporations, creditor committees, trustees, and other stakeholders across industries, navigating intricate insurance matters, multidimensional commercial disputes, reorganization and trust implementation, and transactional risk issues. Gilbert LLP focuses on engineered, outcomes-driven solutions that align with broader business objectives. www.gilbertlegal.com
Seeger Weiss
One of the nation’s preeminent plaintiffs’ law firms, Seeger Weiss is best known for multidistrict mass torts and class actions in both state and federal court—and especially for taking those cases to trial. With the resources and dedication to take on the world’s largest corporations, the firm has an impressive track record of victories against companies like Merck, Monsanto, and 3M—and a reputation for sticking with a case from beginning to end. From offices in New York, New Jersey, and Pennsylvania, the firm has represented over 10,000 individuals, companies, and governments across the United States who have been injured or defrauded on a massive scale. Since its founding in 1999, it has led many of the most complex and high-profile cases in the country: the National Prescription Opiate Litigation, which the Washington Post called “the largest federal court case in U.S. history”; the “Dieselgate” scandal; the sprawling multistate litigation on behalf of survivors of child sexual abuse; and the history-making National Football League Players’ Concussion Injury Litigation. https://www.seegerweiss.com/
Napoli Shkolnik
Napoli Shkolnik is a nationally recognized law firm that has built an impressive track record by bringing a client-focused approach to complex, often large-scale litigation, largely in the areas of mass torts, environmental law, civil rights, product liability and pharmaceutical, commercial litigation and medical malpractice & personal injury. Headquartered in New York, the firm has additional offices across the United States, as well as affiliate offices in Puerto Rico and Canada, affording the resources and reach to effectively pursue difficult cases and win favorable outcomes for its clients. https://www.napolilaw.com
Information source: Texas Medical Association
