Arizona Attorney General Sues MultiPlan, Major Insurers Over Alleged Out-of-Network Price-Fixing Scheme

The lawsuit, filed in Maricopa County Superior Court, names MultiPlan along with insurers Aetna, Cigna, UnitedHealthcare, Humana, Elevance, Molina Healthcare, Centene and Health Care Service Corp. According to a statement from the Arizona Attorney General’s Office, the defendants allegedly relied on a shared algorithm and pooled claims data to determine reimbursement rates for out-of-network services rather than independently negotiating payments.

Mayes said the companies used a common system that incorporated confidential claims payment information from participating insurers to calculate reimbursement amounts, resulting in lower payments to physicians and hospitals. According to a statement from her office, the alleged practice harmed healthcare providers while increasing the financial burden on patients.

“This case is another example of old-fashioned price-fixing using new technology, but it’s against the law all the same,” Mayes said during a press conference Monday in Phoenix.

The attorney general’s complaint contends that insurers effectively delegated out-of-network payment decisions to MultiPlan, which then used shared industry data to determine reimbursement rates. State officials argue that the arrangement reduced competition among insurers and allowed them to pay less than they otherwise would have in a competitive marketplace. According to a statement from the Attorney General’s Office, the alleged scheme left many patients responsible for significant portions of their medical bills.

Read more: MultiPlan and Insurers Move to Dismiss Antitrust Allegations Amid Growing Legal Challenges

Mayes pointed to several examples cited in the lawsuit, including a patient who allegedly received a bill exceeding $100,000 for an out-of-network heart surgery after MultiPlan set a reimbursement amount of $5,449.27. Another patient reportedly faced tens of thousands of dollars in charges related to opioid addiction treatment. According to the complaint, such cases illustrate the financial impact on consumers when insurers reimburse only a fraction of out-of-network costs.

“Families paid more,” Mayes said. “Independent providers struggled to keep their doors open. Patients are forgoing visits to the doctor because their deductibles are growing and the cost of prescription medicine is rising.”

The lawsuit also focuses on preferred provider organization (PPO) health plans, which typically offer members the flexibility to seek treatment outside their insurer’s network. According to a statement from the attorney general’s office, consumers often pay higher premiums for PPO coverage with the expectation that out-of-network care will still receive substantial reimbursement. State officials argue that when insurers pay significantly reduced amounts, those benefits are effectively diminished.

Mayes alleges that the defendants violated Arizona’s Consumer Fraud Act by misrepresenting the value of PPO coverage and by failing to disclose that reimbursement decisions were being driven by a third-party algorithm. The lawsuit also accuses the companies of violating the Arizona Uniform State Antitrust Act by coordinating through shared data and payment methodologies to suppress reimbursement rates across the market. According to a statement from the attorney general’s office, the state is seeking restitution, civil penalties and injunctive relief.

“The more they squeeze our doctors and hospitals, the more MultiPlan makes,” Mayes said.

The lawsuit comes amid broader scrutiny of algorithm-driven pricing systems across multiple industries. Arizona has previously pursued antitrust cases involving software platforms accused of facilitating coordinated pricing practices, and Mayes has compared the allegations against MultiPlan to other technology-assisted price-fixing cases.

MultiPlan, which rebranded as Claritev in 2025, has faced similar allegations in ongoing federal litigation brought by medical providers and professional associations. Plaintiffs in those cases have alleged that the company’s reimbursement platform enabled insurers to coordinate out-of-network payment practices on a national scale.

Source: Court House News