Health Care Antitrust Roundup: Key Cases and Trends for Providers

For in-house counsel and executive teams, these cases carry operational, financial, and contracting implications that extend well beyond the courtroom. Below is a status update on key cases and enforcement trends followed by practical takeaways for providers.

Algorithmic Repricing: MultiPlan/Claritev and Zelis

A consolidated direct-action and parallel class action accuse MultiPlan (rebranded as Claritev) and major insurers of using common algorithms and shared pricing data to suppress out-of-network reimbursements over the last decade. In June, the court denied motions to dismiss, citing allegations that algorithmic alignment can constitute concerted action and that intermediary-facilitated exchange of sensitive pricing information can support Section 1 claims. The US Department of Justice (DOJ) also filed a Statement of Interest essentially endorsing the plaintiffs’ legal theory, if proven.

Providers should inventory exposure to the defendants’ claims and their purported use of MultiPlan/Claritev tools (e.g., Data iSight, Viant), preserve claims data, and evaluate direct-action or class participation strategies given the potential for treble damages.

Providers also have raised concerns about alleged coordinated underpayments involving other third-party repricers, including Zelis. A class action antitrust lawsuit is pending against Zelis Healthcare, alleging price-fixing and market allocation within the health care payment processing industry. The lawsuit contends that Zelis’ practices suppressed competition and artificially lowered provider reimbursements by leveraging proprietary algorithms to unilaterally determine and depress reimbursement rates, sharing competitively sensitive pricing data among payers to enforce these rates, and imposing common terms that restrict provider ability to negotiate.

These cases are just some of the algorithmic pricing and data pooling cases currently being litigated across the country and courts, which are setting out the boundaries for this type of collaboration among competitors. For providers, payers’ repricing through algorithmic methodologies should be reviewed through an antitrust lens, with an eye toward similar contract terms, benefit plan pricing, and payment calculations being applied across payers.

BCBS Provider Antitrust Claims Settlement

Blue Cross Blue Shield (BCBS) finalized a substantial $2.8 billion nationwide settlement addressing class claims of alleged market allocation and price fixing. This settlement represents a significant financial opportunity for eligible providers. The magnitude of individual recoveries will be contingent upon the volume of participating providers and the data they submit — providers with in-network claims with most BCBS entities will receive a settlement payment based on an estimated share, while those that submitted detailed claims data by July 2025 may receive more.

It is notable that several prominent health systems chose to opt out of this class settlement, electing instead to pursue direct legal actions challenging BlueCard policies and alleged territorial restraints. Those cases remain pending.

Alleged Price and Wage Effects in Concentrated Provider Markets

This year, scrutiny intensified on provider systems alleged to use local dominance and contracting leverage to raise prices or restrain wage competition. Below are four illustrative examples.

• Sutter Health (California): State enforcers and private plaintiffs alleged that Sutter used “all‑or‑nothing” systemwide contracting and anti‑steering provisions to command supra‑competitive prices across Northern California. Sutter agreed to pay a substantial monetary settlement and to injunctive relief limiting its use of restrictive terms — often cited as a template for curbing price effects tied to provider market power.

• Atrium Health/Carolinas HealthCare: The DOJ challenged anti‑steering and anti‑tiering restrictions in Atrium’s payer contracts, alleging they hindered insurer efforts to steer patients to lower‑priced competitors and helped sustain higher prices. The case concluded with a prohibition on such restraints, underscoring that steering limits can be anticompetitive even absent a merger.

• Hartford HealthCare: Private plaintiffs advanced claims alleging that Hartford consolidated bargaining power and deployed “all‑or‑nothing” and anti‑steering clauses to elevate prices. The discovery in this case will focus on whether systemwide leverage produced price elevation in affected service lines and geographies.

• Dialysis Providers: Two dialysis providers were sued in federal court in Colorado by two union health plans for allegedly fixing prices for dialysis services and agreeing not to directly compete in many markets. The providers’ motion to dismiss is briefed and awaiting resolution by the court.

Enforcement Climate

The Antitrust Division’s Task Force on Health Care Monopolies and Collusion continued its work in 2025, emphasizing scrutiny of alleged algorithmic coordination, serial acquisitions, and data-sharing practices across insurers, pharmacy benefit managers (PBM), and providers. Expect more requests for information and coordination with the US Department of Health and Human Services on data-related conduct; diligence around benchmarking, shared vendors, and cross-entity data access should be reinforced.

For providers, federal Office of Personnel Management/Inspector General audits identified overcharges to Federal Employees Health Benefits Program plans tied to PBM contracts. TRICARE network changes and specialty‑pharmacy routing have affected access and clinic‑administered drugs. And, new state PBM statutes (e.g., limits on patient steering, pass‑through pricing, and audit rights) are prompting contract updates with hospital‑owned, physician‑dispensing, and specialty pharmacies.

The Federal Trade Commission also pressed health care-related § 8 board interlock cleanups, prompting director resignations to resolve overlaps between competing portfolio companies. Health systems, physician platforms, and private equity sponsors should inventory governance ties across competitors and remediate overlaps before they draw agency attention.

Enforcers have trained attention on alleged wage suppression tied to provider concentration and restraints. Agency scrutiny of travel‑nurse staffing consolidation and investigations into system contracting practices signal that noncompete, no‑poach, and other restrictive covenants are increasingly evaluated for potential monopsony effects alongside traditional price impacts. State Attorneys General have been investing in the use of noncompetes by health care providers as well.

For providers, the practical implication is that contracting, once focused solely on reimbursement, may now require a parallel review for labor‑market risk, especially where a system is a dominant employer in the local area. Providers should also assess revisit noncompete and no-poach language, and document procompetitive justifications for workforce restrictions.

What to Watch in 2026

• Discovery in the MultiPlan MDL will define the contours of algorithm-centric Section 1 claims.

• BCBS opt-outs and follow-on suits will continue to evolve, and their progress, and any reports from the settlement administrator, will be important to monitor.

• New developments in the case against Zelis could reshape how providers might approach claims against Zelis and other third-party repricers.

• Expect to see the DOJ take continued interest in professional accreditation associations practices, including those in the medical field, following its December statement of interest reiterating that professional accreditation associations are subject to antitrust regulation.

• State Attorneys General are increasing their scrutiny of provider activity.