April 2025: DOJ’s Case Against Claritev (MultiPlan)
What to Know & Action Items
April 2025: DOJ’s Case Against Claritev (MultiPlan)
This month’s ROC Meeting focused on one of the most significant legal developments impacting healthcare providers in 2025: the Department of Justice's intervention in the antitrust lawsuit against Claritev (formerly MultiPlan). The case centers around allegations that Claritev, in collaboration with major insurers, leveraged a common pricing algorithm to coordinate reimbursement rates—potentially constituting price-fixing and violating federal antitrust laws.
A huge thank you to Erin Burke, CEO & Founder of Hansei Solutions, and Matt Lavin, Healthcare Litigation Attorney and Partner at Arnall Golden Gregory, for joining us to unpack the implications of this case and what providers should be doing now to protect themselves.
🎥 Missed the meeting? View the recording:
Passcode: aK6=$5Fq
🔍 Overview of the Case: MultiPlan Becomes Claritev
MultiPlan’s Transition to Claritev
🔹 MultiPlan has officially rebranded as Claritev
🔹 The goal: Enhance clarity & innovation in healthcare
What this means for providers:
✅ Name change only—MultiPlan has not been sold
✅ No impact on contracts, pricing, or existing services
✅ Provider agreements remain valid (future amendments will reflect Claritev)
✅ No immediate changes to contact info, provider portals, or ID cards
⚖️ DOJ Intervention: What It Means for Providers
The DOJ’s involvement underscores growing federal concern over algorithmic pricing tools being used to coordinate payor decision-making. The case points to broader industry issues:
🔹 Increased scrutiny on payor-provider dynamics
🔹 Risks of financial recoupments & reimbursement challenges
🔹 Tactics framed as “opportunities” but may undermine providers
What’s at Stake for Providers:
If the case is successful, providers involved in the litigation could recover three times the amount they were underpaid. Under antitrust law, damages are calculated as the difference between the actual market value of services rendered and the reduced rates set by Claritev (formerly MultiPlan)—then multiplied by three. This means the potential financial recovery could be substantial.
📄 FAQ & Legal Resources
Matt Lavin and his team at AGG have put together a helpful FAQ sheet on the case.
Still have questions? Reach out directly to:
Matt Lavin – Matt.Lavin@agg.com
Kiera Gwynn – Kiera.Gwynn@agg.com
✅ Provider Action Items
Stay informed about the DOJ’s case and evolving legal landscape
Contact regulators regarding concerns around network adequacy and underpayment
Reach out to Kiera or Matt about joining the MultiPlan litigation or resolving related disputes (prepayment reviews, denials, recoupments)
We'll continue monitoring this case and sharing updates in future ROC meetings. If you're experiencing any payer-related issues that feel aligned with this case, don't wait—reach out for support and legal guidance.
📚 Additional Reading
Erin Burke
CEO & Founder
Matt Lavin
Healthcare Litigation Attorney & Partner
Kiera Gwynn
Attorney