By admin 
Sixteen rural California hospitals are currently at risk of closure, five of them immediately. For the nearly 2 million Californians who live in rural communities, that threatens access to the emergency rooms, specialty care and maternity services they depend on.
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Across California, physicians who provide medically necessary care — often in emergencies or in specialties where no in-network option exists — are receiving reimbursements that bear little resemblance to the cost of delivering the care. This is contributing to closures here and across the country. According to a major federal antitrust lawsuit now moving through the courts, this is driven by price fixing, not market forces.
The MultiPlan litigation, which consolidates claims brought by hundreds of healthcare providers, alleges that Claritev (which recently rebranded from MultiPlan) worked with the nation’s major payers (including Aetna, Cigna, Elevance and UnitedHealth) and others to create and operate a system that greatly reduced or eliminated competition in the market for out-of-network care.
Instead of determining payments independently, these payers stopped competing with each other and outsourced their rate-setting responsibilities to Claritev, which then used an algorithmic pricing systems to artificially drive payments downward for all the payers. Those rates were far below what a competitive market would have set.
The defendents deny these allegations, saying their cost-containment tools merely recommend reimbursement amounts using legitimate data and that insurers independently decide what to pay.
But, in the lawsuit, providers say they were underpaid by approximately $19 billion in 2020 alone. In that year, Claritev reportedly processed more than 370,000 out-of-network claims each day, representing more than 80% of commercial out-of-network reimbursements nationwide.
The momentum has been on the plaintiffs’ side. In March 2025, the Department of Justice filed a statement of interest arguing that competitors can violate federal antitrust law by exchanging competitively sensitive pricing information through a third-party intermediary, even if they never communicate directly with one another.
Last June, Judge Matthew Kennelly of the Northern District of Illinois ruled that the plaintiffs’ allegations, if proven, would establish violations of federal and state antitrust and unfair competition laws, and allowed the case to proceed into discovery.
On June 24 of this year, Kennelly rejected an attempt by the defendants to avoid liability, ruling that providers’ alleged billing irregularities do not excuse or justify an alleged conspiracy to suppress reimbursement rates. The plaintiffs still must prove their case, but these rulings ensure the allegations will receive a full hearing in federal court.
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The Claritev proceedings cast a spotlight on a problem facing physicians across the country. Many have watched reimbursement for out-of-network care decline dramatically while the process for determining those payments has become increasingly opaque. When reimbursement no longer reflects the resources required to deliver care, the effects ripple throughout the healthcare system.
That is why the California Medical Association joined this litigation on behalf of our members, and why individual providers who believe they have been affected may also be able to pursue their own claims and recover damages.
This case is not simply about resolving past payment disputes. It raises fundamental questions about whether healthcare markets should operate through fair competition or through a reimbursement system that has allegedly allowed dominant insurers to dictate prices with little transparency or accountability.
When physicians cannot sustain independent practices, patients lose access to specialists. When behavioral health providers and addiction treatment centers cannot remain financially viable, communities lose critical services. And when rural hospitals struggle under persistent reimbursement pressures, entire regions may lose access to emergency and specialty care.
These are not abstract economic concerns, they are questions about whether patients can obtain timely medical care close to home. They are, truly, issues of life and death.
By participating in the litigation, the California Medical Association and its members are not seeking inflated prices for medical care. Instead, we believe that healthcare depends on a simple principle: providers who care for patients should be compensated through a fair, transparent, competitive system. If that principle erodes, then patients — not just physicians — bear the consequences.
As this litigation moves forward, we hope it leads to accountability as well as a broader conversation about ensuring that reimbursement systems strengthen — not undermine — access to quality healthcare in California and across the country.
Dr. René Bravo is president of the California Medical Association, representing more than 50,000 physicians and medical professionals across California.
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