The Arizona Attorney General Kris Mayes filed an 83 page lawsuit against MultiPlan and several large health insurers, alleging they quietly built and operated a system that slashed payments to doctors and hospitals — and left Arizonans having to pay more for out-of-network care.

The lawsuit alleges that for years, MultiPlan and insurers Aetna, Cigna, UnitedHealthcare, Humana, Elevance, Molina, Centene, and Health Care Service Corp. relied on a shared algorithm to decide how much to pay for out-of-network care, which relied in part on their collective sharing of confidential, competitively sensitive claims payment information with and through MultiPlan.

Instead of competing or setting payments independently, they allegedly used the same formula and the same data, and delegated payment negotiation decisions to MultiPlan, resulting in extremely low payments across the industry that continued to decrease over time.

This lawsuit targets what the State characterizes as a decade-long buyer’s cartel in the out-of-network healthcare market. The suit draws a direct line to the 2009 Ingenix settlements — in which UnitedHealth Group and co-defendants paid hundreds of millions of dollars for similar algorithmic manipulation of UCR rates — and alleges that MultiPlan “picked up where Ingenix left off.”

Since at least 2015, MultiPlan (operating its “Data iSight” platform) allegedly recruited the nation’s largest commercial insurers into a coordinated arrangement to suppress out-of-network reimbursement rates. The mechanics of the alleged conspiracy are allegedly straightforward:

– –  Insurers fed proprietary claims and pricing data into MultiPlan’s centralized database — information that, in a competitive market, would be closely guarded competitive intelligence.
– –  MultiPlan’s algorithm used this pooled data to reprice every out-of-network claim by CPT code, producing a single fixed rate regardless of geography, provider quality, or market conditions.
– –  Every insurer in the arrangement followed MultiPlan’s pricing output rather than setting reimbursements independently, effectively eliminating price competition among buyers.
– –  Each artificially low payment was fed back into the algorithm, creating a self-reinforcing downward ratchet on reimbursement rates year over year.
– –  MultiPlan’s fee was calculated as a percentage of “savings” generated — meaning its financial incentive was structurally aligned with paying providers as little as possible.
– –  The complaint notes that MultiPlan’s CEO publicly touted a “record quarterly achievement” in Q3 2024 — a $6.4 billion reduction in payments to healthcare providers.
– –  The State alleges that 81% of the out-of-network commercial market is covered by MultiPlan client-payors, giving providers no practical alternative but to accept suppressed rates or forgo those patients entirely.

The complaint identifies three classes of victims:

– –  Providers: Systematically underpaid at rates a 2020 New York State Comptroller study found to be 1.5 to 49 times below UCR rates for 35% of analyzed service codes; rural providers and mental health clinics are described as particularly impacted.
– –  Patients: PPO enrollees who paid higher premiums specifically for out-of-network flexibility were left with unexpected balance bills when insurers reimbursed at suppressed algorithmic rates. The State alleges the scheme was not disclosed to consumers.
– –  Employers and Self-Funded Plans: Employers offering PPO plans and administering self-funded plans through MultiPlan-participating insurers were also subjected to the artificially managed pricing structure.

The lawsuit is based upon two alleged Causes of Action.  Count I — Arizona Uniform State Antitrust Act (A.R.S. § 44-1402): The complaint alleges a per se illegal horizontal conspiracy among competing buyers to fix prices. The relevant market is defined as out-of-network healthcare services covered by commercial and self-funded plans (excluding No Surprises Act-covered emergency services). Civil penalties up to $150,000 per violation are available. Count II — Arizona Consumer Fraud Act (A.R.S. § 44-1522): Insurers allegedly misrepresented the value and nature of PPO coverage by marketing “flexibility” and “freedom” in provider choice while concealing that a third-party algorithm — not the insurer — was determining provider payment rates. Civil penalties up to $10,000 per willful violation apply.

The State of Arizona seeks: (a) full restitution to harmed patients, providers, and employers; (b) disgorgement of defendants’ ill-gotten gains; (c) a permanent injunction barring participation in the MultiPlan arrangement and requiring each defendant to independently establish its own out-of-network rate methodology; (d) civil penalties under both statutes; and (e) attorneys’ fees and investigation costs. A jury trial has been demanded on all triable issues.

The complaint references MultiPlan’s nationwide operations and notes that the same tool produces identical suppression in every state. Other state attorneys general may follow Arizona’s lead, particularly given the AG’s explicit reference to the Ingenix settlements as a template.

This is a wage-and-hour class action that, as the court itself observed, has outlasted nearly every comparable case in California history — the original complaint was filed 19 years ago, and the matter has already generated multiple interlocutory appeals and writ proceedings, including review by the California Supreme Court (North American Title Co. v. Superior Court (2024) 17 Cal.5th 155).

Roughly 700 escrow officers and escrow-related employees of North American Title Company (now known as Lennar Title, Inc., referred to as “NATC”) sued over alleged failure to pay overtime and provide meal and rest breaks. The employees were divided into two certified classes: a “Nonexempt” class alleging they were pressured to work “off the clock,” and an “Exempt” class of roughly 400 employees alleging they had been misclassified as exempt and were therefore owed overtime. The escrow officers held a wide variety of job titles, worked in more than 80 offices across 23 counties, and earned compensation that frequently included substantial incentive pay — some class members earned well over $250,000 in a year.

The central legal question was whether class members spent more than half their workday on duties qualifying as “exempt work” under California’s quantitative test for the relevant Labor Code exemptions.

Before trial, both classes dismissed their statutory Labor Code claims and proceeded solely under the Unfair Competition Law (UCL). The case was tried in two bifurcated phases. In the first phase (the so-called “liability phase,” tried in 2015), the court limited each side to roughly 100 witnesses to prove or refute the claims of all 700 class members. Following that phase, the court ruled against NATC on its exemption defenses on a classwide basis, decertified the Nonexempt class, and — critically — appointed a referee to conduct a second phase to determine UCL restitution for the Exempt class. The court did this without the parties’ consent and over NATC’s strenuous objections.

The reference proceedings stretched on for years and included live testimony from more than 230 individual class members. The trial court then adopted nearly all of the referee’s findings and ultimately entered a judgment of roughly $43.5 million against NATC (more than half of which was prejudgment interest). Judgment was entered against NATC and for the Exempt class, but in NATC’s favor against two named plaintiffs, Kimberly Baker and Carolyn Cortina (the original plaintiff), who had not testified at trial. Both sides appealed.

The Fifth District reversed for the most part in the partially published case of Cortina v. North Am. Title Co. -F085389 (May 2026). It affirmed the judgment only as to codefendant North American Services, LLC (which prevailed below) and as to one individual plaintiff, Janet Doran. In all other respects the judgment was reversed, the case was ordered decertified as a class action, and the matter was remanded for retrial of the named plaintiffs’ individual claims (with leave for the trial court to entertain a new certification motion as to the Exempt class). On the plaintiffs’ cross-appeal, the court also reversed the judgment that had gone against Baker and Cortina, allowing them to pursue their claims on retrial. The court identified two independent grounds compelling reversal.

First, the nonconsensual reference was unauthorized. Under the California Constitution (Cal. Const., art. VI, §§ 21, 22) and Code of Civil Procedure section 638, a court may refer a matter to a referee without the parties’ consent only in narrowly limited circumstances. (People v. Superior Court (Laff) (2001) 25 Cal.4th 703.) The court held that delegating years of restitution proceedings — including testimony from 230-plus class members on contested liability-type issues — fell outside those limited categories. It described a nonconsensual reference of this scope and magnitude as not merely rare but apparently unprecedented in California law, and concluded this error alone required reversal.

Second, the first phase of trial violated the controlling principles of Duran v. U.S. Bank National Assn. (2014) 59 Cal.4th. Duran requires that statistical sampling used to establish classwide liability rest on a scientifically valid methodology — expert-determined sample size, an acceptable margin of error, and randomly selected witnesses. Here, plaintiffs sought to prove the Exempt class’s claims through testimony from only about 15 percent of one cohort (roughly 24 of 156 “Branch Managers”) offered as “representative,” without meeting any of Duran’s methodological requirements. Because some class members (such as Branch Managers) indisputably performed exempt work, the absence of valid common proof meant the trier of fact had no reliable basis to extrapolate to a classwide judgment. (Marlo v. United Parcel Service, Inc. (C.D. Cal. 2008) 251 F.R.D. 476.) The court also faulted the trial court for rejecting NATC’s affirmative defenses wholesale based on misinterpretations of law and for barring NATC from questioning second-phase witnesses on its exemption defenses.

Under Duran, “decertification must be ordered whenever a trial plan proves unworkable,” and the court held the unworkability of the plan was apparent by the end of the first phase. Combined with the prejudicial errors, this warranted not only reversal but decertification by the appellate court itself.

Finally, on the cross-appeal, the court held the judgment against Baker and Cortina could not stand once the broader judgment was reversed, and remanded so they too could litigate their individual claims on retrial. Notably, the opinion was certified for publication except for Part III (the cross-appeal discussion).

Michelle Paknad, a former employee of Intuitive Surgical, Inc., filed suit against the company and two former supervisors after she was fired, alleging sexual harassment, gender discrimination, and unlawful retaliation. While still employed, Paknad had lodged two formal internal complaints, which Intuitive responded to by retaining outside attorney Andrea Kelly Smethurst to conduct independent investigations. Smethurst interviewed witnesses, reviewed documents, and produced two detailed reports — each organized into five parts covering Paknad’s allegations, witnesses and documents reviewed, summaries of witness interviews, factual findings, and legal conclusions with recommendations to management. Intuitive shared only a summary of findings with Paknad and withheld the underlying reports entirely.

In defending against Paknad’s lawsuit, Intuitive asserted an “avoidable consequences” affirmative defense, touting the investigations as thorough and independent. Intuitive’s interrogatory responses stated that it had “thoroughly investigated every allegation that plaintiff presented by hiring an independent, outside investigator to conduct two investigations, interview numerous witnesses, and reviewed a large volume of documentary evidence.”

When Paknad moved to compel production of the Smethurst reports and investigative materials, the trial court initially denied the motion, finding the materials shielded by attorney-client privilege and attorney work product protection.

That ruling led to the first round of appellate review (Paknad v. Superior Court, May 20, 2024, H050711 (Paknad I)), in which the Court of Appeal found that Intuitive had waived both privileges by placing the scope and adequacy of the investigations at issue, and directed the trial court to grant Paknad’s motion — subject to in camera review to determine whether any narrow protection survived.

On remand, the trial court reviewed Intuitive’s proposed redactions in camera and accepted them. Intuitive had redacted all of Part IV (Smethurst’s factual findings) and substantial portions of Part V (Smethurst’s conclusions and legal recommendations), reasoning that every redacted passage reflected attorney mental impressions, conclusions, or legal theories, rendering them absolutely protected core work product under California Code of Civil Procedure section 2018.030, subdivision (a). The court granted the motion to compel only as to the unredacted remainder — effectively stripping out all of Smethurst’s factual determinations before turning over the reports.

The Court of Appeal denied Paknad’s second petition for writ of mandate, however ruled upon it after remand from the Supreme Court. In the published case of Paknad v. Superior Court  (Paknad II) -H052652 (April 2026), the Court of Appeal directed the trial court to vacate its August 27, 2024 order, conduct a further in camera review, and order disclosure of all materials within the scope of Intuitive’s waiver.

The Court of Appeal held that the trial court had asked the wrong question. Rather than asking whether the redacted materials constituted core work product, the court was required to ask whether those materials fell within the scope of Intuitive’s waiver — a distinct inquiry that the trial court never performed.

The appellate court clarified that Paknad I had found waiver of both the attorney-client privilege and core attorney work product protection, following two controlling authorities. In Wellpoint Health Networks, Inc. v. Superior Court (1997) 59 Cal.App.4th 110, the court held that an employer who defends an employment lawsuit by relying on the thoroughness and propriety of its internal investigation waives both the attorney-client privilege and the work product doctrine as to that investigation. In People v. Superior Court (Jones) (2021) 12 Cal.5th 348, the California Supreme Court confirmed that even core work product is subject to waiver when the holder voluntarily places the protected material at issue — there, a prosecutor who relied on an undisclosed juror rating system to justify peremptory challenges waived work product protection as to that system.

Applying those principles, the court held that Intuitive’s waiver extended to: (1) all of Smethurst’s factual findings about Paknad’s allegations of discrimination, harassment, or retaliation; and (2) any information in the reports or investigative materials bearing on the scope or adequacy of Smethurst’s investigations. The factual findings were directly relevant to both prongs — they revealed how Smethurst weighed evidence and assessed witness credibility, and they were essential for Paknad to evaluate Intuitive’s repeated claim that the investigations were independent and objective. Because Intuitive put Smethurst’s independence at issue, Paknad was entitled to access the findings to assess whether bias infected the process.

The court rejected Intuitive’s argument that the redacted findings were shielded because they reflected legal judgment and experience, reasoning that having voluntarily commissioned and then weaponized those findings in its defense, Intuitive could not simultaneously disclaim their investigative character to preserve them from disclosure.

On remand, the court directed that further in camera review focus not on whether materials constitute core work product, but solely on whether they fall within the scope of what Intuitive placed at issue — and any such material must be disclosed to Paknad regardless of its work product character.