AG Mayes filed  a lawsuit against MultiPlan and several large health insurers, alleging they quietly built and operated a system that slashed payments to doctors and hospitals — and left Arizonans having to pay more for out-of-network care. The lawsuit alleges that for years, MultiPlan and insurers Aetna, Cigna, UnitedHealthcare, Humana, Elevance, Molina, Centene, and Health Care Service Corp. relied on a shared algorithm to decide how much to pay for out‑of‑network care, which relied in part on their collective sharing of confidential, competitively sensitive claims payment information with and through MultiPlan. Instead of competing or setting payments independently, they allegedly used the same formula and the same data, and delegated payment negotiation decisions to MultiPlan, resulting in extremely low payments across the industry that continued to decrease over time.

“MultiPlan and major insurance companies across Arizona allegedly conspired to keep payments to providers low in a scheme to pad their profit margins. By using a shared algorithm to set payments, these companies harmed doctors and patients alike — driving up patients’ risk of paying more out‑of‑pocket costs, depriving providers of fair payment and sometimes forcing them to accept payment below the costs incurred for treatment, and making it harder for Arizonans to get the care they needed. This case is another example of old-fashioned price-fixing using new technology, but it’s against the law all the same.” -AG Mayes