Teaser - April 8th: Key Billing Red Flags to Watch Out for in 2025 & DOJ’s Case Against Claritev (MultiPlan)
Protecting Your Revenue in Light of Recent Legal Developments
Key Billing Red Flags to Watch Out for in 2025 & DOJ’s Case Against Claritev (MultiPlan)
The Department of Justice (DOJ) has intervened in the antitrust lawsuit against Claritev, formerly known as MultiPlan, supporting medical providers' claims that the company's use of a common pricing algorithm with major health insurers may constitute price-fixing and violate federal antitrust laws.
The DOJ's involvement underscores the growing concern over algorithmic technologies being used to coordinate decision-making among competitors, which can undermine market competition. In response to the lawsuit, MultiPlan and several health insurers, including Aetna, Cigna, and United Healthcare, have filed motions to dismiss the case, denying any wrongdoing. The DOJ, however, has challenged these motions, asserting that the defendants' arguments for dismissal are legally flawed.
This development highlights the increased scrutiny on payor-provider dynamics and the potential risks associated with algorithm-driven pricing practices in the healthcare industry.
Join us in our next Masterminds meeting on Tuesday, April 8th, where we’ll break down:
🔹 The DOJ’s stance and what it means for providers
🔹 Key billing tips & tricks to watch out for in 2025
🔹 Real-world examples of providers facing financial recoupments
🔹 How these tactics are presented as “opportunities” – and the risks involved
🔹 How to navigate out-of-network plans in light of these legal and reimbursement challenges
With increased scrutiny on reimbursement practices, understanding these challenges is critical for providers looking to protect their revenue. Join us for an in-depth discussion on how to navigate these legal and financial risks.
