#United States #Alexandria #Antitrust Lawsuit #APTA #Fair Payment

APTA Joins Fight for Fair Reimbursement in U.S. Healthcare

In a significant legal move, the American Physical Therapy Association (APTA) and APTA Private Practice have positioned themselves as plaintiffs in a federal antitrust lawsuit targeting major health insurance companies. This lawsuit was filed in the U.S. District Court for the Northern District of Illinois against MultiPlan, a company that recently rebranded as Claritev, alongside some of the largest insurance providers in the nation, including UnitedHealth, Elevance (formerly Anthem), Humana, Aetna, Cigna, and several Blue Cross Blue Shield affiliates.

The core of the complaint revolves around allegations that these entities have engaged in a systematic conspiracy to lower reimbursement rates for out-of-network healthcare services. Specifically, this lawsuit addresses the issue of price-fixing, claiming that the insurers are coordinating their efforts to underpay physical therapists and other healthcare providers, thus threatening the financial stability of these professionals.

According to APTA President Kyle Covington, PT, DPT, PhD, physical therapists have suffered from a payment system that not only undervalues their services but also compromises patient access to essential care. Covington asserts, “Anticompetitive and unlawful reimbursement practices are harming our profession, limiting patient choice, and driving up healthcare costs. This legal action marks a critical step toward fighting against systemic barriers to fair and lawful payment.”

Moreover, the lawsuit highlights a striking statistic—the MultiPlan entity alone handles over 80% of all commercial out-of-network reimbursement claims within the United States, indicating a centralization of power that may exacerbate the issue of underpayment.

APTA Private Practice President Mike Horsfield, PT, MBA, voiced his concern, stating, “Physical therapists have been systematically exploited by unlawful pricing schemes that leave us underpaid, overburdened, and legally handcuffed. The era of complacency has ended.” His statement underscores the frustration felt within the physical therapy community, emphasizing that the lawsuit seeks to hold accountable the companies believed to be engaging in these harmful practices.

As the lawsuit progresses, APTA will offer resources and guidance to its members, including a webinar aimed at informing therapists about the possibility of pursuing individual legal actions. This initiative exemplifies APTA's commitment to empowering its members and fostering a more equitable healthcare environment.

Despite the challenges ahead, APTA remains resolute in advocating for fair reimbursement practices. Kyle Covington concluded, “APTA remains unwavering in our commitment to securing fair payment for physical therapist services and advancing a healthcare system grounded in value, transparency, and patient-centered care.”

In essence, the actions taken by APTA and APTA Private Practice signal a concerted effort to combat the inequities experienced by physical therapists in the current reimbursement landscape, aiming to effect substantial changes that will enhance patient care and ensure fair compensation for healthcare providers.

This move has drawn considerable attention within the healthcare sector, indicating that other professionals may soon follow suit in addressing similar challenges. As APTA navigates this complex legal terrain, it emphasizes the importance of solidarity among practitioners and advocates for transparency and fairness in healthcare payments.

APTA will continue to keep its members informed on developments in the lawsuit, ensuring that they are well-equipped to advocate for their rights amid evolving healthcare dynamics.