In another development in the ongoing litigation over the enforceability of Independent Dispute Resolution (“IDR”) awards issued under the No Surprises Act (“NSA”), two air ambulance providers, Guardian Flight LLC and Med‑Trans Corporation, have filed a petition for writ of certiorari with the U.S. Supreme Court, seeking review of the
Payors
No Surprises Here! New York and Florida Courts Reject Provider Suits to Enforce NSA IDR Awards, Heightening Pressure for Appellate Review
In a pair of recent back-to-back rulings, Federal district courts in Florida and New York have held that the No Surprises Act (“NSA”) does not permit providers to bring private causes of action to enforce Independent Dispute Resolution (“IDR”) awards issued under the NSA. Following on the heels of earlier…
Proskauer Secures Landmark Settlement with New York State to Expand Access to Children’s Mental Health Services
By Michael Menconi on
[This blog post was originally published on Proskauer’s Social Responsibility and Pro Bono blog here.]
A Proskauer team, along with Disability Rights New York (DRNY), Children’s Rights (CR) and the National Health Law Program (NHeLP), reached a preliminary settlement agreement with the State of New York in C.K. v.
No Surprises Here! Connecticut District Court Confirms IDR Awards Are Enforceable Under the NSA, Deepening Judicial Divide Over Award Enforcement Mechanisms
By Vinay Kohli & D. Austin Rettew on
The U.S. District Court for the District of Connecticut has become the latest court to weigh in on whether Independent Dispute Resolution (“IDR”) awards issued under the No Surprises Act (“NSA”) are enforceable. In a recent decision, the District Court has held that providers may sue to enforce arbitration…
DOJ’s Civil Rights Fraud Initiative: Key Considerations for Health Care Providers
The Department of Justice’s (“DOJ”) May 19, 2025 “Civil Rights Fraud Initiative” memorandum, issued by Deputy Attorney General Todd Blanche (the “Initiative”), marks a consequential policy shift for False Claims Act (“FCA”) enforcement. The Initiative instructs every U.S. Attorney’s Office to “aggressively pursue” compliance with federal civil rights laws, as those laws have been interpreted by the Supreme Court under the 2023 Harvard admissions decision. The effect of this order is to treat a recipient’s knowing violation of federal civil rights laws as a “false claim” whenever that recipient has certified, impliedly or expressly, that it would comply with those laws as a condition of receiving federal dollars.
CMS to Immediately Begin Auditing Medicare Advantage Plans in Significant Expansion of Enforcement Efforts
On May 21, 2025, the Centers for Medicare and Medicaid Services (“CMS”) announced a significant expansion of its auditing efforts with respect to Medicare Advantage (“MA”) plans.
For newly initiated audits of MA plans, CMS will audit all eligible MA contracts for each payment year. Additionally, for audits already initiated…
Disproportionate Impact: Supreme Court Narrows Disproportionate Share Hospital Reimbursement to Supplemental Security Income Cash Recipients
The U.S. Supreme Court has issued a significant ruling affecting hospitals that serve low-income Medicare beneficiaries, narrowing the interpretation of the Disproportionate Share Hospital (“DSH”) payment formula. In Advocate Christ Medical Center v. Kennedy, the Court determined that only Medicare patients who were eligible to receive a cash Supplemental…
This New Year, California Imposes Guardrails on the Use of AI by Payors for Utilization Management Determinations
By Whitney Phelps, Jonian Rafti & Michael Menconi on
SB 1120 (the “Bill”), which takes effect on January 1, 2025, amends existing California law to adopt guardrails around the use of artificial intelligence tools for the purpose of utilization management.[1] As discussed in a prior Proskauer alert, the Bill represents one of the latest attempts by the…
No Surprises Here! Fifth Circuit Upholds QPA Calculations and Disclosure Requirements, but Sides with Providers on Payment Deadlines
By Vinay Kohli & D. Austin Rettew on
The Fifth Circuit Court of Appeals has handed down a significant decision in response to a challenge from health care providers to the implementing regulations of the No Surprises Act (“NSA”). The Court upheld the Departments of Treasury, Labor, and Health and Human Services’ (the “Departments”) approach to certain key…
No Surprises Here! Fifth Circuit Upholds Health Care Provider Challenge to No Surprises Act Regulations
By D. Austin Rettew & Vinay Kohli on
In a recent win for health care providers, the United States Court of Appeals for the Fifth Circuit has affirmed a lower court’s decision to vacate key portions of regulations issued by the U.S. Departments of Treasury, Labor, and Health and Human Services (collectively, the “Departments”) under the No Surprises…