- The Texas Medical Association won its lawsuit in a federal district court, resulting in nationwide relief for physicians using the independent dispute resolution process.
A federal district court judge in Texas on February 23 vacated specific provisions pertaining to the independent dispute resolution process of the government’s regulations for the No Surprises Act. In a lawsuit filed by the Texas Medical Association (TMA), US District Court Judge Jeremy Kernodle granted the association’s motion for summary judgement and provided nationwide relief for all physicians and other health care providers who use the independent dispute resolution process.
The decision is a victory for physicians, including pathologists, who have fought against the unjust regulations. In a similar case led by the American Medical Association (AMA) and American Hospital Association (AHA), the CAP filed an amicus brief that warned the government’s requirements for the independent dispute resolution process heavily favored insurers and would cause substantial harm to physicians. The AMA-AHA case has yet to be decided.
Neither the lawsuit, nor the judge’s decision in the Texas Medical Association case, will affect provisions banning surprise medical bills. The CAP and other physician groups strongly advocated to include these patient protections in the law.
No Presumption in Law Favors Qualified Payment Amount
Importantly, the decision simply removes the rulemaking that required arbitrators in the independent dispute resolution process to begin with the presumption that the qualifying payment amount (median-in-network rate) for an out-of-network service is the appropriate amount. In the TMA case, the judge agreed with the Texas physicians’ claims the Biden administration did not follow procedural obligations for the federal rulemaking process and that no presumption to give more weight to the qualified payment amount existed in the law.
The physician and hospital groups, along with the CAP, have challenged the flawed regulations for the independent dispute resolution process. The law clearly established a fair and impartial process where physicians and other providers can settle claims with insurers without patients receiving unexpected large medical bills. The TMA, and AMA and AHA lawsuits state that the federal government’s regulations deviated from the law and ensured that commercial insurers can routinely undercompensate physicians.
The government has 60 days to make a decision on appeals, and it is unclear if they will do so or not.
The CAP will continue tracking this case and report additional updates to members as they develop.