The Coalition Against Surprise Medical Billing (CASMB)—representing leading employer groups, unions and health insurance providers—sent a letter to the Trump administration strongly opposing Guidehouse, Inc.’s petition to become a Certified Independent Dispute Resolution (IDR) Entity under the terms of the No Surprises Act. Guidehouse’s ownership by Bain Capital, a private equity firm with extensive health care investments, creates a clear and unacceptable conflict of interest that would undermine the integrity of the IDR process.
Allowing a Bain-owned entity to arbitrate out-of-network disputes would be tantamount to having the fox guard the hen house. Guidehouse’s business model centers on maximizing revenue for health care providers and facilities, while its parent company, Bain Capital, maintains substantial investments throughout the health care industry—including in provider groups and service companies that stand to benefit from favorable IDR outcomes. Such inherent conflicts of interest make Guidehouse unsuitable for the impartial role required of IDR Entities.
Private equity firms have a long, well-documented and troubling history of exploiting the surprise medical billing system that the No Surprises Act was designed to end. Their business model prioritizes revenue maximization over quality care, frequently resulting in inflated charges, upcoding and unnecessary procedures. Such practices were a driving force behind the creation of the No Surprises Act.
The No Surprises Act was enacted to protect patients from the abusive billing practices that private equity-backed companies helped proliferate. Firms like TeamHealth (owned by Blackstone), Envision Healthcare (owned by KKR) and SCP Health (owned by Onex) were architects of the surprise billing crisis, using out-of-network status to extract exorbitant payments from insurers, employers, unions and patients. Given this troubling track record, entrusting dispute resolution to another private equity-owned entity would directly contradict the legislation’s protective intent.
The scale of private equity dominance in IDR disputes underscores these concerns. According to data from the Centers for Medicare & Medicaid Services (CMS), in the first half of 2024, 47% of all cases originated from just four private equity-backed organizations: Team Health, SCP Health, Radiology Partners and Envision. Moreover, 45% of filed cases were challenged as ineligible, highlighting the systemic manipulation of the process by these entities.
Allowing a conflicted, private equity-backed entity like Guidehouse to be certified in the role of a neutral arbiter in these disputes—deciding what is an appropriate out-of-network rate for health care—is incompatible with the intent of the No Surprises Act and would lead to skewed decisions favoring financially motivated interests rather than patient protections.
CMS must maintain a rigorous standard for IDR Entities, ensuring the No Surprises Act protects patients, not profits. Certifying Guidehouse would compromise the transparency, fairness and neutrality essential to the IDR process.
Read CASMB’s full letter to CMS online here.
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