On May 22, U.S. Senators Ron Wyden (D-OR), Chair of the Finance Committee and Bernie Sanders (I-VT) Chair of the Health, Education, Labor and Pensions (HELP) Committee issued a letter to Travis Dalton, CEO of MultiPlan. Mr. Dalton is being called upon to address the findings from an investigation by a New York Times (NYT) reporter that exposes MultiPlan’s business model, which financially incentivizes health insurers to under-reimburse medical claims to gain a higher “Percentage of [Shared] Savings” from the amount not paid to the provider. In other words, the less the provider is paid and the patient exposed for a lager bill, the more the third-party administrator and MultiPlan will keep for themselves.
MultiPlan has publicly stated that healthcare payors and providers alike rely on “MultiPlan’s services and tools to avoid costly negotiations and ensure strong and more efficient relationships” among all interested parties. MultiPlan states in 2023 alone, it identified over $22B in savings for payors, employers and consumers in the healthcare industry.
Notwithstanding, the U.S. Senate Finance and HELP Committees have concerns that MultiPlan’s Data iSight product improperly drives up patient health care costs and, further, the financial incentives built into the fee for the use of the Data iSight product results in an improper conflict of interest between determining a plan’s liability for out-of-network claims and the plan’s duty to provide promised benefits pursuant to ERISA. Mr. Dalton has been asked to brief the Committees on the allegations contained in the April 7th New York Times investigation no later than June 5, 2024.
Cohen Howard has been working to get out-of-network providers reasonably paid for more than ten years. Our firm has witnessed first-hand how payors and MultiPlan have worked together to depress reimbursement rates to providers and saddle patients with exorbitant medical bills while collecting billions of dollars in the process. Working directly with our litigation network of co-counsel, Cohen Howard, has initiated several lawsuits against MultiPlan and many of the large commercial payors. In some cases, we are seeking class certification over the exact issues identified in the NYT Investigation. Several cases have survived procedural efforts by defendants for dismissal and have moved to discovery proceedings:
- Stewart et al v. CIGNA Corporation et al, Case No. 3:22-cv-00769-OAW. Zuckerman Spaeder
- Popovchak et al v. UnitedHealth Group Incorporated et al, Case No. 1:22-cv-10756-LLS. Zuckerman Spaeder
- Shapiro et al v. Aetna Inc. et al, Case No. 2:22-cv-01958-ES-AME. Buttaci Leardi & Werner LLC.
- Tamburrino, M.D. et al v. UnitedHealth Group Inc. et al, Case No. 2:21-cv-12766-SDW-ESK. Buttaci Leardi & Werner LLC.
- Redstone, M.D. et al v. Aetna, Inc. et al, Case No. 2:21-cv-19434-JXN-JBC. Buttaci Leardi & Werner LLC.
- Hott, M.D. v. Multiplan, Inc. et al, Case No. 1:21-cv-02421-LLS. Buttaci Leardi & Werner LLC.
- Atlantic Neurosurgical Specialists, PA v. Multiplan, Inc. et al, Case No. 1:20-cv-10685-LLS. Buttaci Leardi & Werner LLC.
Our team remains committed to out-of-network surgeons, many of whom are microsurgeons, that perform some of the most complex and advanced surgical procedures. From our experience over the last decade, the patterns and practices used by commercial payors and third-party administrators may vary slightly but the goal is always the same… to under-reimburse surgeons for the care provided to patients.
Should you have any questions or need help obtaining reimbursements for your out-of-network claims please contact us immediately for assistance.
