Provider Lawsuit Could Tie Up Surprise Billing Regulations

Dec 17
Dec 17, 2021

The U.S.’s two largest health care provider groups, the American Medical Association (AMA) and the American Hospital Association (AHA), sued the Biden administration on Dec. 9, asking a federal court to block regulations officials developed to implement the No Surprises Act, parts of which will come into effect on Jan. 1. Health care attorneys tell AIS Health that the suit may hinge on the providers’ allegation that federal officials stretched their legal authority too far beyond the Act’s original intent — and that the providers might win.

The AMA and AHA (joined in the suit by two hospital systems and two North Carolina physicians) accuse the Biden administration of creating rules for the “independent dispute-resolution process that would unfairly benefit insurance companies,” in the words of an AMA press release. The provider groups target an Oct. 7 interim final rule in their lawsuit, arguing that the IFR’s guidance to the arbitrators who will decide balance billing disputes “deviates from Congress’s balanced design.” According to the providers’ legal complaint, the Biden administration’s rulemaking disrupted an “approach that did not skew towards either providers or insurers” that Congress arrived at through “compromise.”
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Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.