Pacific Inpatient Medical Group Inc. et al. v. Zelis Healthcare LLC et al.

Docket No.
1:25-cv-10734
District Court
Massachusetts

Goal

  • Award damages
  • Block defendant action
  • Certify class
  • Declaration that defendant action is unlawful

Issues

This lead case has been consolidated with two other similar lawsuits, Ayer et al. v. Zelis Healthcare, LLC (1:25-cv-11092) and Danny Bachoua Chiropractic, APC et al. v. Zelis Healthcare, LLC (1:25-cv-11167). All filings post-consolidation are reflected below. Collectively, this litigation is referred to as In re: Zelis Repricing Antitrust Litigation.

Why This Matters:

Why This Matters: 

Plaintiffs, a group of health care providers, bring a class action suit alleging that major private insurers colluded with a health care finance company to suppress payments to out-of-network providers in violation of the Sherman Act. Specifically, the providers allege that the insurers relied on a “repricing” software to generate artificially low reimbursement payments, instead of negotiating fair rates.

Potential Impact:

Potential Impact: 

Anticompetitive practices by major health insurers could undermine competition within health care markets leading to higher costs and lower-quality care for patients.

 

49 Major Filings

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Related Litigation

Current Status

Briefing is ongoing

Important Date

Joint Status Report Due

Legal Issues

Sherman Act

Date Filed
March 28, 2025
Case Type
Civil
Court Type
District Court
Court
Massachusetts
Judge
Murphy, Brian E. Appointed By: Joseph R. Biden Jr.
Plaintiff(s)
Pacific Inpatient Medical Group Inc.; Dennis C. Ayer DDS LLC; Frank J. Scaccia LLC.; James Paul Allen LLC; Danny Bouchoua Chiropractic APC
Lead Counsel For Plaintiff(s)
Paul LLP; Hartley LLP
Defendant(s)
Zelis Healthcare LLC; Zelis Claims Integrity LLC; Zelis Network Solutions LLC; Aetna Inc; The Cigna Group; The Elevance Health Companies Inc.; Humana Inc.; UnitedHealth Group Inc.
Lead Counsel for Defendant(s)
Ropes & Gray LLP