On October 24th, the American Medical Association (AMA) and the Illinois State Medical Society (ISMS), filed a lawsuit in federal court in Chicago, seeking injunctive relief against what they termed, “a multilateral price-fixing conspiracy” with the nation’s largest insurance companies. Rather than setting their own rates for out-of-network reimbursement, most of the nation’s commercial payors outsource this function to a company called MultiPlan. The AMA and ISMS believe that MultiPlan operates as a “cartel” to depress payments for out-of-network care with the largest players in the health insurance industry acting as “co-conspirators” to stifle competition for out-of-network contractual arrangements.
This system all but eliminates competition between insurers for out-of-network provider services. The AMA believes this scheme to be unlawful and that it harms physicians by denying fair payment for out-of-network health care services. The AMA law site argues that this scheme constitutes price-fixing and is thus a violation of the Sherman Anti-Trust Act. It has generated immense profits for both MultiPlan and the commercial health insurance companies that use its services, while forcing physicians to accept lower and lower payment amounts for out-of-network services. In many cases, the physician payments do not cover the cost of delivering that care. As a result, many medical practices have stopped offering certain services or have closed their doors . Ultimately, it’s the patients who are harmed.
Here’s a link to the complaint:
