MultiPlan Out-of-Network Underpayment Litigation

Out-of-network claims that a health plan repriced downward are not necessarily a closed billing cycle. A federal antitrust case may mean recoverable revenue for healthcare providers whose out-of-network claims were repriced downward for years. For CFOs, VPs of revenue cycle, and health system finance leaders, that repricing may represent recoverable revenue already sitting inside your own claims data.

Mokaram Injury Lawyers is a Houston, Texas firm with a healthcare and commercial litigation practice that reviews provider-side out-of-network underpayment. On this litigation, our firm works alongside Devin van der Hahn of VanderHahn LLP, a Houston-based trial firm whose practice centers on healthcare litigation and business disputes. The case is federal, not a Texas-law matter. Call 281-222-2222 or request a free case review to speak with our team.

The Issue: A Federal Antitrust Case Over Out-of-Network Repricing

A consolidated federal antitrust case, In re MultiPlan Health Insurance Provider Litigation (MDL No. 3121), a multidistrict litigation combining similar federal cases before one judge, U.S. District Court for the Northern District of Illinois, Hon. Matthew F. Kennelly, alleges that competing health plans relied on a shared repricing method to hold down out-of-network reimbursement across the industry. Plaintiffs describe the underpayment as systemic rather than claim-by-claim. According to the complaint, the repricing services at issue belong to MultiPlan, recently renamed Claritev.

Hospital associations and other industry groups have filed amicus briefs supporting the plaintiffs’ position, and additional health systems and medical associations have joined the litigation since it was filed.

In March 2025, the U.S. Department of Justice filed a Statement of Interest supporting the plaintiffs’ antitrust theory — a filing that reflects the government’s reading of the law, not a finding of fact. In June 2025, the court denied the bulk of the defendants’ motions to dismiss, and the antitrust claims are now proceeding into discovery. Devin van der Hahn, whose healthcare litigation practice includes MultiPlan-related matters, has been tracking the case through this stage.

How the Alleged Pricing Arrangement Worked

According to the complaint, insurers sent out-of-network claims data to a shared third-party pricing vendor. The vendor’s tool returned reimbursement recommendations, and participating health plans could apply them to provider payments. Antitrust law’s concern is not the software itself — it is that competitors who are supposed to set prices independently instead drew on a shared pool of rival data. Plaintiffs allege this suppressed reimbursements across the industry, the kind of conduct Section 1 of the Sherman Act prohibits.

Where the Case Stands

The litigation has moved past the pleading stage. Motions to dismiss were largely denied in June 2025, and the case is now in discovery. Antitrust claims are proceeding on two tracks: a class track under Rule 23 of the Federal Rules of Civil Procedure, and an individual direct-action track for organizations that would rather control their own case. Devin van der Hahn works with our team at Mokaram Injury Lawyers to help provider organizations weigh which track fits their situation.

Once discovery wraps, the court is expected to schedule bellwether trials — test cases used to gauge how similar claims might play out — before addressing the full docket.

Why This Matters to Your Margin

The exposure plaintiffs describe is not a single denied claim. It is a repeated pattern across a large volume of out-of-network payments, and the filings are what size it, not us.

• Duration: The alleged conduct spans up to a decade of claims history.
• Scale: The litigation describes hundreds of health plans as part of the alleged conduct.
• Remedy: Under Section 4 of the Clayton Act, a business harmed by conduct the antitrust laws forbid can recover three times its actual damages plus the cost of suit, including a reasonable attorney’s fee, where liability is established.
• Momentum: Additional health systems and medical associations have joined the litigation since it was filed.

We are not stating a damages figure or a recovery estimate here. Any recovery would turn on what your own claims data shows and whether it is pursued through the class track or an individual direct action, not on the allegations in the complaint.

Providers Most Exposed to Underpayment Risk

Exposure concentrates in specialties with high out-of-network claim volume, often in settings where the patient does not choose the provider:

• Hospitals and health systems with out-of-network volume across service lines — small repricing differences add up fast at hospital claim volumes
• Emergency and hospital-based physician groups billing outside networks — patients do not choose their treating physician
• Ambulatory surgery centers with facility and professional components — facility fees are frequently billed out of network
• Anesthesiology, radiology, and pathology practices — patients do not choose these providers either
• Behavioral health and outpatient facilities — out-of-network status is often the model, not the exception

A high out-of-network mix is a signal, not proof. The exposure question turns on your organization’s own remittance history.

What Healthcare Finance Leaders Should Do Now

Before deciding whether to submit a claim, healthcare finance leaders should:

1. Pull out-of-network remittance advice and explanation-of-benefits data as far back as your systems reach, and look for third-party repricing in the payment record.
2. Read payor contracts for arbitration clauses, which can settle the forum before anyone argues the merits.
3. Identify the service lines and facilities behind your out-of-network volume.
4. Bring the findings to counsel to determine next steps.

How a Reimbursement Review Works

A reimbursement review starts with a sample of your own remittance history, before you commit to anything:

1. You send us a sample remittance file and a claims extract.
2. We check that sample against the repricing pattern described in the litigation.
3. You receive a written read on whether your claims show signs of out-of-network underpayment.
4. You decide what happens next. Nothing is owed before that point.

A sample review, not a full data pull, is the right first step, so the initial cost is low. Older claims are usually harder to source, so a review works best while records are still accessible.

Mokaram Injury Lawyers was founded by Ali Mokaram, who has practiced law in Texas since 1995. On this litigation, we work alongside Devin van der Hahn, Managing Partner and Founder of VanderHahn LLP, a Houston firm focused on healthcare litigation and business disputes, and Co-Founder of White Hill Litigation Partners. Before founding his own firm, he practiced complex commercial litigation at Quinn Emanuel Urquhart & Sullivan. Live support is available 24/7, and reviews of this kind are handled on a contingency basis, with no fee unless there is a recovery.

Frequently Asked Questions

Talk to Our Team About a Free Case Review

The next step is a free case review of a sample of your out-of-network remittance data. Revenue recapture starts with your own remittance data, and older claims are usually harder to source, so a review works best while records are still accessible. Call 281-222-2222, any hour, or start an out-of-network reimbursement review online. You can also read about the attorneys at our firm.