Provider Lawsuit Could Tie Up Surprise Billing Regulations

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.”

© 2022 MMIT

Peter Johnson

Peter has been a reporter for nearly a decade. Before joining AIS Health, Peter covered a wide variety of topics in his hometown of Seattle, where he continues to live. Peter’s work has appeared in publications including The Atlantic and The Stranger. Peter attended Colby College.

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