APTA AND APTA PRIVATE PRACTICE JOIN FEDERAL LAWSUIT OVER HEALTH CARE PRICE-FIXING

The following information was released by the American Physical Therapy Association:

The associations demand fair payment for physical therapists and condemn illegal repricing practices.

APTA and APTA Private Practice have joined the MultiPlan Antitrust Litigation as plaintiffs. This federal antitrust litigation alleges a conspiracy to systematically underpay physical therapists and other health care providers for reimbursements of out-of-network services.

MultiPlan, recently rebranded as Claritev, and leading health insurance companies, including UnitedHealth, Elevance (Anthem), Humana, Aetna, Cigna, and various Blue Cross Blue Shield entities, have been alleged as participating in a coordinated price-fixing conspiracy to increase their profit margins by setting increasingly low reimbursement rates for out-of-network services.

In a joint statement by APTA and APTA Private Practice, the association leaders reaffirmed their organizations' commitment to fair payment for physical therapists and condemned the illegal repricing practices.

"For too long, physical therapists and their practices have been forced to operate within a payment system that undervalues their expertise and undermines patient access to the high-quality care they provide," says APTA President Kyle Covington, PT, DPT, PhD. "Anticompetitive and unlawful reimbursement practices are harming our profession, limiting patient choice, and driving up health care costs. This legal action marks a critical step toward fighting against systemic barriers to fair and lawful payment."

APTA Private Practice President Mike Horsfield, PT, MBA, states, "Physical therapists have been systematically exploited by unlawful pricing schemes that leave us underpaid, overburdened, and legally handcuffed. The era of complacency has ended." Horsfield goes on to say, "This lawsuit is about holding the bad actors accountable and putting real money back into the hands of those whove earned it. Our members are fed up, and so are our patients. We will not back down until we see justice, reform, and the end of these predatory reimbursement practices."

This lawsuit, filed in the Northern District Court of Illinois in 2024, seeks to end MultiPlans alleged anticompetitive scheme, which has operated since at least 2015, and recoup financial damages for health care providers and practices. As of 2024, MultiPlan processes more than 80% of all commercial out-of-network reimbursement claims in the United States.

What does APTA and APTA Private Practice joining the MultiPlan Antitrust Litigation mean for members?

APTA is participating in the lawsuit as an organizational plaintiff, seeking an injunction to stop the alleged anticompetitive scheme. This action does not make individual APTA members parties to the lawsuit.

Individual practices may be entitled to significant financial damages against MultiPlan and other insurance companies.

Affected members will have the opportunity for the same law firms representing APTA to bring individual claims for financial damages due to the repricing.

For individual APTA members who engage one of the law firms representing APTA in this litigation, representation would be on a contingency basis at a reduced rate.

Claims against MultiPlan over out-of-network reimbursements may go back 10 years. Many practices that have been out-of-network with one major insurer during the relevant time period will have compensable claims.

For more information on commercial insurance out-of-network repricing, download APTAs Practice Advisory.

An informational webinar discussing opportunities for therapists to sue on an individual basis will be held with lawyers appointed in the litigation for individual, direct action plaintiffs. Sign up to be notified when the webinar date, time, and registration are live to learn more.

Advancing payment is APTAs top priority.

"APTA remains unwavering in our commitment to securing fair payment for physical therapist services and advancing a health care system grounded in value, transparency, and patient-centered care," Convington concludes.

Stay tuned for important updates from APTA and APTA Private Practice as the case progresses.