Recently, a federal judge in New Jersey confirmed an arbitration award in favor of an insurer resulting from the independent dispute resolution (“IDR”) process created under the No Surprises Act. This is one of the first times an IDR award has been confirmed by the courts and demonstrates that the FAA’s presumption in favor of arbitration awards will apply to IDR determinations even without reasoned awards.
GPS, a medical practice in New Jersey, performed emergency plastic surgery on a patient in 2022. Following the procedure, GPS submitted a bill to Horizon, the patient’s ...
Finds that the U.S. Department of Health and Human Services put its “thumb on the scale”
On Monday February 8, a judge in the Eastern District of Texas again rejected the U.S. Department of Health and Human Services (HHS) Independent Dispute Resolution (IDR) rules on the grounds that the Rules continued to “put a thumb on the scale” for the arbitrator’s reliance on the Qualified Payment Amount (QPA) contrary to the statutory language of the No Surprises Act.
On September 30, 2021, the federal Departments of Treasury, Labor, and Health and Human Services issued “Requirements Related to Surprise Billing; Part II,” the second in a series of interim final regulations (the “Second NSA Rules”) implementing the No Surprises Act (“NSA”). This new federal law became effective for services on or after January 1, 2022.
Medical providers preparing to engage in arbitration with payors pursuant to the just-announced No Surprises Act dispute rules should be prepared to counter some tough tactics from payors. For health care providers, the first Interim Final Rule represents a reasonable solution against arbitrary rates for out-of-network services, but raises concerns that certain policies may result in a financial windfall for insurers at the expense of providers and consumers.
On July 1, 2021, the Departments of Treasury, Labor, and Health and Human Services issued “Requirements Related to ...
Blog Editors
Recent Updates
- Third Circuit Holds that the Public Disclosure Bar Precludes Qui Tam Actions Based on Information Available on Publicly Accessible Databases
- Supreme Court of Ohio Rules on a Peer-Review Privilege Issue in Stull v. Summa
- Agency Actions Remain Judicially Unreviewable Where Congress Has Legislated Clear Agency Authority - SCOTUS Today
- The Loper and Jarksey Era: Agency Power to Award Civil Penalties in SEC and FINRA Under Increased Scrutiny
- Navigating Regulatory Challenges in the Dietary Supplement Industry: Insights on NJ Assembly Bill No. 1848