A judge for the U.S. District Court for the District of Massachusetts denied a motion to dismiss a lawsuit alleging an antitrust conspiracy by healthcare technology company Zelis and five major health insurers, according to a March 30 court filing.
Providers in California, New Jersey, Wisconsin and Kansas formed the basis of the consolidated action, which targets the vendor, as well as Aetna, Cigna, Elevance Health, Humana and UnitedHealth Group.
Zelis specializes in network management and claims integrity. The lawsuit alleges the insurers used the vendor’s repricing tools to lower out-of-network reimbursements. Zelis takes a percentage of the difference between what the provider charges and what the carrier actually pays, the filing said.
In one instance, Zelis repriced a charge at an 88% discount, the lawsuit says. The plaintiffs say this has hurt small medical practices and that providers’ out-of-network revenue was reduced by at least half, prompting practices to consider other business arrangements or the possibility of shutting down.
The first complaint in the consolidated action dates to March 2025, and defendants filed a motion to dismiss in August. Relief could include damages and an injunction.
“Last week’s motion was procedural and does not change Zelis’ position,” a Zelis spokesperson said in a statement shared with Becker’s. “Zelis operates with a strong commitment to integrity, transparency and full compliance with all applicable laws and regulations. Zelis uses common, publicly available data sources when making its recommendations to managed care organizations and third-party administrators. We remain confident the facts will show these lawsuits are without merit.”
Last year, an Illinois federal judge allowed a case that alleged MultiPlan, now Claritev, and insurers conspired over reduced reimbursement to progress without the unjust enrichment claims. In 2024, a California judge dismissed another lawsuit against MultiPlan, where a health system alleged billions in denied provider payments.
Becker’s contacted all five insurers and will update this story if more information becomes available.
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