Compliance Stuff

Congress enacted the No Surprises Act ( NSA ) to protect patients from unexpected medical bills . A central pillar of the  NSA  is its independent dispute resolution ( IDR ) process, under which payers and providers can submit disputed claims to binding arbitration. Since the IDR process under the NSA began in April 2022, hundreds of thousands of claims have been submitted. As arbitrators have handed down awards, largely in favor of providers, a critical question has emerged — are these final and binding judgments privately enforceable? Two recent federal decisions, one from the District of Connecticut and one from the Fifth Circuit, have reached opposite conclusions. Guardian Flight LLC v. Aetna Life Ins. Co. , No. 3:24-cv-680-MPS (D. Conn. May 14, 2025):   Private Right of Action Exists In  Guardian Flight LLC v. Aetna Life Insurance Co ., the District of Connecticut addressed whether air ambulance providers could bring suit in court to enforce unpaid or late-...

In  Neurological Surgery Practice of Long Island, PLLC v. US Department of Health and Human Services et al. , the court dismissed a provider’s challenge to the federal agencies’ implementation of the independent dispute resolution entity (IDRE) selection procedures under the NSA. Providers should be aware of the court’s deference to agency discretion, the limitations on judicial remedies, and the ongoing regulatory developments that may impact future IDR proceedings. In the  case , a private neurosurgery practice in New York brought suit against the US Departments of Health and Human Services, Treasury, and Labor, alleging that the agencies’ procedures for selecting IDREs under the NSA were unlawful . The court reviewed the statutory framework of the NSA, which requires that providers and payers jointly select an IDRE within a three-business-day window. If the parties cannot agree, the agencies’ regulations provide that the initiating party (typically the provider) proposes a...