West Islip, N.Y.-based Long Island Anesthesiologists has lost its antitrust lawsuit against UnitedHealthcare and MultiPlan after a federal appeals court ruled that steep cuts to out-of-network reimbursement rates do not constitute an antitrust injury, according to court documents reviewed by Becker’s.
What happened?
- In a Feb. 6 summary order, the U.S. Court of Appeals for the Second Circuit affirmed the dismissal of the anesthesiology group’s claims, finding the alleged harm stemmed from lawful bargaining behavior and changes in reimbursement law, not illegal anticompetitive conduct.
- Until January 2022, the Empire Plan, which covers roughly 1.2 million state and local government employees, retirees and dependents and once accounted for 40% of the practice’s revenue, was treated as subject to New York’s Surprise Bill Law, which required insurers to pay out-of-network providers a “reasonable amount.” The plan later determined it was governed by the federal No Surprises Act, which relies on a different payment framework.
- Long Island Anesthesiologists alleged reimbursements under the federal law were roughly 80% lower and sued UnitedHealthcare, which administers the Empire Plan, and MultiPlan, which provides repricing services, alleging violations of federal and state antitrust laws.
- The appeals court rejected those claims, holding that lower reimbursement rates alone do not constitute anticompetitive conduct. The court said insurers are permitted to bargain aggressively and that UnitedHealthcare’s actions reflected standard business practices.
- The panel also rejected allegations that UnitedHealthcare and MultiPlan engaged in a horizontal conspiracy to suppress rates.