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
Surprise Billing
No Surprises Here! Shareholder Derivative Lawsuit Challenging Provider Use of No Surprises Act IDR Process Portends New Corporate Governance Risks
By Vinay Kohli & D. Austin Rettew on
On September 8, 2025, a shareholder of Nutex Health, Inc. (“Nutex”) filed a derivative action in the Southern District of Texas that places the No Surprises Act (“NSA”) squarely at the center of a corporate-governance fight. Specifically, the complaint alleges that Nutex’s heavy reliance on the NSA’s independent dispute resolution…
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…
No Surprises Here! Payers Push Back on IDR Submissions, Opening New Front in NSA Implementation Landscape
On May 27, 2025, Blue Cross Blue Shield Healthcare Plan of Georgia (“BCBSGA”) sued several emergency physician groups and their billing agent, Halo MD, alleging abuse of the No Surprises Act’s (“NSA”) independent dispute resolution (“IDR”) process. The complaint claims the providers submitted ineligible claims, made false attestations, and inundated…
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…
No Surprises Here! CMS Audit Uncovers Non-Compliance by Aetna in Calculation and Disclosure Requirements Under the No Surprises Act
By D. Austin Rettew & Vinay Kohli on
In a recent audit, the Centers for Medicare & Medicaid Services (“CMS”) uncovered non-compliance by Aetna Health Inc. of Texas (“Aetna”) in calculating key payment information for air ambulance services under the No Surprises Act (“NSA”). These audit results highlight the ongoing challenges faced by providers and payors in…
No Surprises Here! Divergent Court Rulings Spotlight Ongoing Challenges in No Surprises Act Implementation; Tee Up Split in Authority on Award Enforcement Mechanisms
By D. Austin Rettew & Vinay Kohli on
Two District Courts have reached opposite conclusions on the enforceability of arbitration awards under the No Surprises Act (“NSA”). The two decisions, while far from the final word on the subject, highlight the most recent challenge relating to the implementation of the NSA.
Enacted by Congress in 2020, the NSA…
The Devil may be in the Details of the Part II No Surprises Act IFR
By Edward S. Kornreich & Angela Gichinga on
This post reviews Part II of the federal No Surprises Act regulations. In previous publications, we have commented upon the No Surprises Act, and Part I of the regulations.
The “Requirements Related to Surprise Billing; Part II” (the “Part II Rule”), published on October 7, 2021, is the second interim final rule (IFR) implementing the No Surprises Act, following a prior No Surprises Act IFR (the “Part I Rule”) published on July 13, 2021. Both of these regulations are generally set to take effect on January 1, 2022.
In this post, we outline how the Part II Rule addresses: (A) the independent dispute resolution (IDR) and open negotiation processes for health plans and other payers (“Plans”), (B) patient-provider dispute resolution processes for uninsured individuals, and (C) the expansion of the federal external review provisions of the Affordable Care Act to cover disputes regarding the application of the No Surprises Act.