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Houston Methodist vs. Big Insurance

Source: Houston Chronicle — https://www.chron.com/news/article/houston-methodist-lawsuit-insurance-21171404.php
Houston Methodist, one of Texas’ largest and most influential hospital systems, has officially joined a sweeping national lawsuit that accuses several major health-insurance companies and a data-analytics firm, Claritev (formerly known as MultiPlan), of unlawfully manipulating how out-of-network medical claims are priced. According to the lawsuit, these insurers and Claritev allegedly used proprietary algorithms and reimbursement-pricing tools to artificially suppress the rates paid to hospitals and healthcare providers when patients received care outside of their insurer’s preferred network. The filing argues that this system created a hidden, coordinated pricing structure that benefited insurers financially by keeping payouts low while providers absorbed the financial strain of being under-reimbursed for the same medical services.
The lawsuit paints a detailed picture of how this alleged arrangement worked behind the scenes. Hospitals claim that insurers would feed patient data and billing information into Claritev’s platform, which would then generate…


