Nearly three years after the No Surprises Act (“NSA”) became effective, there have been many surprises along the way. From the four lawsuits by the Texas Medical Association challenging the implementation of the Act, revisions to rules put forth by … [Read more...] about The No Surprises Act: A Practical Perspective
A History of Legal Battles: The Texas Medical Association’s Multi-Lawsuit Campaign under the No Surprises Act
Last week, the U.S. Fifth Circuit Court of Appeals held that regulations implemented by the Departments of Health and Human Services, Labor, and Treasury were permitted to include "ghost rates"—contracted rates for services that were never actually … [Read more...] about A History of Legal Battles: The Texas Medical Association’s Multi-Lawsuit Campaign under the No Surprises Act
Fifth Circuit Upholds TMA II Decision
Late on Friday, August 2, the Fifth Circuit Court of Appeals upheld a crucial ruling in the Texas Medical Associations (TMA) II lawsuit, marking another substantial victory for out-of-network providers and the TMA. This landmark decision affirms … [Read more...] about Fifth Circuit Upholds TMA II Decision
US SENATORS SUMMON MULTIPLAN’S CEO TO DISCUSS ALLEGED NEFARIOUS BUSINESS PRACTICES
On May 22, U.S. Senators Ron Wyden (D-OR), Chair of the Finance Committee and Bernie Sanders (I-VT) Chair of the Health, Education, Labor and Pensions (HELP) Committee issued a letter to Travis Dalton, CEO of MultiPlan. Mr. Dalton is being called … [Read more...] about US SENATORS SUMMON MULTIPLAN’S CEO TO DISCUSS ALLEGED NEFARIOUS BUSINESS PRACTICES
NY Times Investigation Exposes Multiplan & Insurer’s Hidden Financial Incentive Practices
Last Sunday the New York Times published two articles written by journalist Chris Hamby, regarding Multiplan and the major health insurance companies. His investigation exposed the "Percentage of Savings Model", used by Multiplan and insurers that … [Read more...] about NY Times Investigation Exposes Multiplan & Insurer’s Hidden Financial Incentive Practices
Federal Texas Court Orders Government Agencies to Vacate NSA Fee Increase and Batching Rule
As previously reported, the Texas Medical Association (TMA) filed a series of lawsuits over the rules implemented by the Departments under the No Surprises Act. On August 3, 2023, Judge Kernodle, US District Court of Eastern Texas, ruled in favor of … [Read more...] about Federal Texas Court Orders Government Agencies to Vacate NSA Fee Increase and Batching Rule
Federal Government Appeals No Surprises Act (NSA) TMA II Decision Concerning the QPA
In a recent development surrounding the implementation of the No Surprises Act (NSA), the United States Department of Justice (DOJ) has filed an appellate brief to appeal the Texas Medical Association (TMA) II decision. This decision vacated certain … [Read more...] about Federal Government Appeals No Surprises Act (NSA) TMA II Decision Concerning the QPA
NJ DOBI Issued Bulletin No. 23-05, June 28, 2023, Non-Discriminatory Coverage for Transgender Individuals
In an effort to promote equal access to healthcare and coverage, the New Jersey Department of Banking and Insurance has published Bulletin No. 23-05 following Governor Murphy’s issuance of Executive Order 326, “Protecting Gender-Affirming Health Care … [Read more...] about NJ DOBI Issued Bulletin No. 23-05, June 28, 2023, Non-Discriminatory Coverage for Transgender Individuals
Court Decision in TMA Lawsuit Good News for Providers
This week, a Texas US Federal District Court granted a summary judgement in favor of the Texas Medical Association (TMA) setting aside and vacating the latest qualifying payment amount (QPA) Rule as violating the No Surprises Act (NSA). The Court … [Read more...] about Court Decision in TMA Lawsuit Good News for Providers
Federal Agencies Levy Substantial Increase in Administrative Filing Fees for NSA IDR in 2023
Late Friday afternoon on December 23, 2022 and well after most had begun celebrating their holiday, CMS quietly announced that it was increasing the non-refundable administrative fee for all IDR filings initiated under the No Surprises Act from $50 … [Read more...] about Federal Agencies Levy Substantial Increase in Administrative Filing Fees for NSA IDR in 2023
Texas Medical Association Files 3rd Lawsuit Challenging NSA Rule
On Wednesday, November 30, 2022 the Texas Medical Association (TMA) filed its third lawsuit against the Departments of Health and Human Services, Labor and the Treasury (the “Departments”) claiming that the final revised rule under the No Surprises … [Read more...] about Texas Medical Association Files 3rd Lawsuit Challenging NSA Rule
No Surprises Act Final Rule Issued…Good News for Providers
On Friday, August 19, 2022, the U.S. Department of Labor and related Federal regulatory agencies issued final No Surprises Act rules “only for certain issues critical to the implementation and effective operation of the Federal IDR process”. These … [Read more...] about No Surprises Act Final Rule Issued…Good News for Providers