How a Landmark Healthcare Antitrust Case Could Affect Inland Empire Providers, Employers, and Patients

Federal litigation challenging out-of-network reimbursement practices could reshape California’s healthcare landscape and influence how providers are paid for years to come.

INDUSTRY INSIGHT

By Matthew M. Lavin, Jennifer Scullion, and Hunter Shkolnik

A major federal antitrust lawsuit challenging how health insurers reimburse out-of-network medical providers could have far-reaching implications for hospitals, physician practices, employers, and patients throughout the Inland Empire.

The case, In re MultiPlan Health Insurance Provider Litigation, is pending in federal court in Chicago and has become one of the nation’s most closely watched healthcare antitrust lawsuits. Plaintiffs—including the California Medical Association and more than 450 healthcare organizations nationwide—allege that MultiPlan, now operating as Claritev, worked with several of the country’s largest health insurers, including Aetna, Cigna, Elevance, and UnitedHealth, to suppress reimbursement rates for out-of-network medical care.

The defendants deny the allegations, and the litigation remains in the discovery phase. However, several recent court rulings have allowed key claims to proceed, making the case one that healthcare providers and business leaders across California are increasingly watching.

Why It Matters to the Inland Empire

Healthcare is one of the Inland Empire’s largest economic sectors. Major institutions such as Loma Linda University Health, regional hospitals, independent physician groups, specialty practices, urgent care centers, and behavioral health providers collectively employ thousands of people and provide care to one of California’s fastest-growing populations.

For many independent medical practices, reimbursement for out-of-network services represents an important source of revenue. According to the plaintiffs, reimbursement practices challenged in the lawsuit have resulted in payments significantly below competitive market rates, creating financial pressure for providers.

If reimbursement rates remain depressed, healthcare organizations may delay hiring, reduce services, postpone investments, or limit expansion. Those business decisions could ultimately affect patient access to care and the employers whose workforces depend on local healthcare providers.

The Allegations

At the center of the lawsuit is MultiPlan’s role in determining reimbursement recommendations for out-of-network healthcare claims.

According to the plaintiffs, competing insurance companies shared confidential pricing information through MultiPlan, which analyzed the data using proprietary products, including Data iSight and Viant, to generate reimbursement recommendations that insurers allegedly adopted across much of the marketplace.

The plaintiffs contend that this system reduced competition among insurers and resulted in reimbursement rates below what would otherwise exist in a competitive market.

MultiPlan has stated that its platform processes more than 80% of out-of-network claims nationwide. The plaintiffs allege that the reimbursement system resulted in approximately $19 billion in underpayments during 2020 alone, with the financial impact continuing to grow in subsequent years.

The defendants dispute these allegations, and the claims have not been proven in court.

Growing Regulatory Attention

The litigation has also attracted attention from federal and state regulators.

In March 2025, the U.S. Department of Justice filed a Statement of Interest arguing that competitors may violate federal antitrust law by exchanging competitively sensitive pricing information through a third-party intermediary, even if they never communicate directly with one another.

Separately, Arizona Attorney General Kris Mayes filed a lawsuit in June 2026 against MultiPlan and several insurers alleging violations of Arizona antitrust and consumer protection laws.

The case has also drawn comparisons to the Department of Justice’s challenge to RealPage’s rent-pricing software, reflecting broader scrutiny of algorithms and centralized data platforms that may influence competitive markets.

Recent Court Rulings

The litigation has continued to advance through several significant procedural victories for the plaintiffs.

In June 2025, the federal court ruled that, if the plaintiffs’ allegations are ultimately proven, they could establish violations of federal and state antitrust and unfair competition laws. The decision allowed the principal claims to move forward.

More recently, U.S. District Judge Matthew Kennelly rejected one of the defendants’ affirmative defenses, ruling that allegations regarding provider billing practices could not excuse the alleged reimbursement scheme if the plaintiffs ultimately prove their claims.

The court also approved amendments allowing additional defendants to be added to several bellwether cases.

Discovery remains ongoing, with 36 representative bellwether cases scheduled to proceed toward trial beginning in September 2028.

Potential Business Implications

Regardless of how the litigation is ultimately resolved, the case highlights broader questions about the role of pricing algorithms, third-party data platforms, and market competition in healthcare.

Healthcare providers argue that preserving competitive reimbursement is essential to maintaining access to quality medical care, particularly for independent physician practices and specialty providers that often operate on narrow financial margins.

Supporters of the lawsuit contend that stronger competition could improve financial stability for providers while helping preserve access to healthcare services in communities across California, including the Inland Empire.

The defendants maintain that their reimbursement practices are lawful and appropriate, and the court has not reached any conclusions regarding the merits of the case.

A Case Worth Watching

As one of the most significant healthcare antitrust cases currently moving through the federal courts, the MultiPlan litigation could influence how out-of-network reimbursement is determined for years to come.

For Inland Empire healthcare providers, employers, and patients, the outcome may have implications extending well beyond the courtroom—potentially affecting provider operations, healthcare access, and the economics of one of the region’s largest industries.

About the Authors

Matthew M. Lavin is a healthcare litigation partner at Gilbert LLP. Jennifer Scullion is an antitrust and complex litigation partner at Seeger Weiss LLP. Hunter Shkolnik is a mass tort and complex litigation partner at Napoli Shkolnik. Together, they serve as counsel for hundreds of Direct-Action Plaintiffs in In re MultiPlan Health Insurance Provider Litigation (MDL No. 3121), pending in the U.S. District Court for the Northern District of Illinois.

The views expressed in this article are those of the authors and do not necessarily reflect the views of the Inland Empire Business Journal.