Federal government notches rare win in surprise billing lawsuit

Healthcare DIVE November 5, 2024
Sydney Halleman

Last week, the 5th Circuit Court of Appeals sided with the federal government’s original interpretation of the No Surprises Act in determining how a key metric in billing disputes is calculated.

Dive Brief:

• Insurers can once again use a wider variety of rates in calculating a key metric meant to help arbiters determine fair payment amounts in disputes with providers over out-of-network bills, thanks to a recent appeals court decision.
• Last week, the 5th Circuit Court of Appeals reversed rulings made by a district court that excluded ghost rates, rates stemming from case-specific agreements and bonus and incentive payments from determining the qualifying payment amount, or QPA — a key metric in disputes over surprise billing.
• The ruling is...

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