California court rules out-of-network rates can be subject to antitrust law
A California Court of Appeal has ruled that out-of-network reimbursement rates are not exempt from state antitrust laws. The court reversed a lower court decision in a case brought by VHS Liquidating Trust, the bankruptcy liquidator for the former Verity Health System. VHS alleged that MultiPlan Corporation (now Claritev) engaged in price-fixing. The court describes MultiPlan as a company that “uses proprietary algorithms to suggest the reimbursement rates insurers and other third-party payors should pay” for out-of-network care. The appellate court held that payments for out-of-network services are prices under the Cartwright Act, meaning they can be subject to antitrust liability if fixed or tampered with. The ruling lets the case proceed; the price-fixing claims remain allegations.