The Next Wave of Healthcare Litigation

The $2.67 billion Blue Cross Blue Shield Provider Settlement addressed market power.

The $575 million Sutter Health Settlement challenged restrictive contracting

practices.

The ongoing Acute Care Hospital Opioid Settlements focused on accountability and cost recovery.

Each of those cases examined large-scale structural conduct in healthcare.

The next wave of healthcare litigation is shifting direction. It is less about traditional market share disputes and more about system dependence. Rather than asking who controls a market, today’s cases are asking who controls the infrastructure.

Following In re Blue Cross Blue Shield Antitrust Litigation, UFCW & Employers Benefit Trust v. Sutter Health, and the ongoing acute care hospital opioid settlements, new lawsuits are targeting the pricing systems, reimbursement platforms, and operational models that providers and health plans rely on every day.

Below is a look at several key healthcare class actions MCAG is actively monitoring, and how they may impact providers, employers, health plans, and other payors.

Where Providers Are Feeling It

Reimbursement Is Becoming a Systems Issue: MultiPlan & Zelis

In In re MultiPlan Health Insurance Provider Litigation (MDL 2996), hospitals allege that out-of-network payments were driven by centralized repricing systems and algorithmic pricing tools rather than independent negotiations. The case has survived major dismissal challenges and is now moving through discovery, making it one of the most closely watched reimbursement cases in healthcare.

Similarly, the Zelis Repricing Antitrust Litigation challenges the role of payment intermediaries in repricing out-of-network claims, focusing on whether platform-driven pricing practices suppressed reimbursement across providers.

This issue is not limited to healthcare. Algorithmic pricing and centralized data platforms are drawing increased legal attention across multiple industries, including real estate, technology, and financial services, where plaintiffs argue that digital pricing tools can facilitate coordinated pricing behavior.

Delta Dental: Network Structure Challenged

In the Delta Dental Antitrust Litigation (MDL 2931), dental providers allege that Delta Dental entities engaged in market allocation and suppressed reimbursement rates through coordinated network structures.

Although class certification was denied, the case remains active.

PBMs: From Courtroom Battles to Federal Enforcement

Cases against CVS Caremark, OptumRx, and Express Scripts continue to test pharmacy reimbursement practices, DIR fees, and vertically integrated pharmacy models. Some matters are moving into arbitration, while others remain active in federal court.

At the same time, the Federal Trade Commission has expanded its enforcement efforts against the largest PBMs, reaching a “landmark” settlement with Express Scripts over insulin rebate practices and pausing its administrative cases while engaging in active settlement talks with OptumRx and Caremark.

PBMs have often been described as “middlemen” in the drug supply chain. Regulators and courts are now examining more closely how that role operates and whether their structure benefits or burdens patients, providers, and payors.

Technology & Equipment Market Power: From Surgical Robots to Hospital Beds

Litigation involving Intuitive Surgical’s Da Vinci surgical robots includes claims that hospitals paid inflated prices due to alleged anticompetitive conduct in the surgical robotics market. The Da Vinci case recently advanced with class notice issued to qualifying purchasers, while a settlement has yet to be reached.

Similarly, Reading Hospital v. Hill-Rom alleges anticompetitive practices in the hospital bed market, impacting direct purchasers.

Together, these cases show that hospitals are not just healthcare providers — they are major commercial purchasers. New cases are increasingly analyzing the dynamics of the equipment sectors they rely on.

Employers & Health Plans

Employers and self-funded health plans are increasingly tied to lawsuits challenging how healthcare is priced and administered.

The U.S. Anesthesia Partners litigation, proceeding alongside DOJ enforcement, involves a proposed class of entities that paid for hospital-only anesthesia services in Texas, reflecting continued legal pressure on consolidation and pricing in physician services.

Cases involving BCBS Michigan’s stop-loss structures and CVS’s third-party administration services challenge how administrative relationships are designed.

Meanwhile, PBM-related lawsuits are also affecting employers and health plans, as challenges to pharmacy reimbursement and rebate structures directly impact plan costs, member premiums, and overall drug spend.

The Bigger Picture

Looking ahead, the next wave of healthcare class action settlements is more likely to stem from pricing systems, reimbursement formulas, and operational models than from traditional market monopolization claims. As healthcare becomes more interconnected and centralized, the financial impact of these systems is increasingly felt across providers, employers, and health plans.

For healthcare organizations, the question is not only where risk exists —but where recovery opportunities may arise. Understanding how your organization fits within these structures can shape how you respond when the next settlement emerges.