New AHIP/BCBSA survey adds to growing evidence of private equity’s rampant misuse of the No Surprises Act arbitration process at the expense of employers, consumers
WASHINGTON — Certain private equity-backed providers and arbitration middlemen’s rampant abuse and misuse of the federal arbitration system has created a new affordability crisis for employers and consumers, threatening to undermine one of the key goals of the No Surprises Act. In 2024 alone, survey respondents said nearly 40% of provider disputes were ineligible under the law, yet most still advanced through arbitration—forcing health plans, employers and unions to pay exorbitant costs on unlawful claims, according to a new survey from AHIP and the Blue Cross Blue Shield Association (BCBSA).
The AHIP/BCBSA survey reinforces findings from a recent Georgetown University analysis that found the arbitration process—including the high volume of ineligible claims submitted by providers—has already contributed to $5 billion in wasteful spending. The analysis noted that “in disputes filed by HaloMD, the median amount was 934% of the [Qualifying Payment Amount.]” These escalating costs ultimately fall on patients and employers and undermine the patient protections intended under the No Surprises Act.
“The No Surprises Act was supposed to protect patients from the direct cost of surprise bills and reduce the cost of care for employers and working families. It has succeeded at the former, but the arbitration process has become the ‘worst case scenario’ for employers by driving up unnecessary and wasteful spending at a time when every health care dollar and penny matters,” said Shawn Gremminger, President and CEO of the National Alliance of Healthcare Purchaser Coalitions. “The Trump administration and Congress need to actively crack down on the bad actors who continue to use the arbitration process to profiteer off employers and consumers.”
The Coalition Against Surprise Medical Billing (CASMB)—which represents leading employers, unions, health plans and consumer and patient allies—urges a comprehensive and urgent overhaul of the arbitration process, given systemic and ongoing abuse by repeat offenders.
This pattern of abuse is clearly reflected in the survey data, which reveal that “[Independent Dispute Resolution Entities (IDREs)] tasked with determining eligibility of a dispute are failing to identify most ineligible disputes submitted by providers. Because of this, ineligible disputes are being considered by IDREs, and unnecessary high costs are being added to the health care system because payment determinations are being issued on ineligible out-of-network disputes.”
The survey found that up to 39% of disputes initiated in 2024 were ineligible—yet many still resulted in mandatory payment determinations by the IDREs. These included claims for services payable under Medicare or Medicaid, disputes already resolved through arbitration and then resubmitted, disputes involving in-network providers and claims subject to a state surprise billing law
Overall, the survey notes “on average, 15% of final payment determinations issued by IDREs were for disputes identified as ineligible by the health plans.”
“The No Surprises Act was intended to protect patients and lower costs, but the numbers, which are undisputed, show the opposite is happening,” said James Gelfand, President and CEO of The ERISA Industry Committee. “It’s abundantly clear by the volume of arbitration claims—many ineligible in the first place—that private equity is using IDR to blow up health care costs for patients, often multiplying their profits by a factor of 10.”
To date, the volume of arbitration disputes has far exceeded original projections. When the No Surprises Act was passed, regulators expected roughly 17,000 disputes annually. However, from mid-2022 through May 2025, more than 3.3 million disputes were filed, demonstrating that arbitration is no longer serving as a “last resort” but as a go-to private equity and arbitration middleman business model.
Indeed, the Centers for Medicare & Medicaid Services’ (CMS) own data show that two private equity-backed provider groups consistently dominate the arbitration process: Radiology Partners (and its affiliates) and TeamHealth. In 2023–2024, Radiology Partners accounted for 28% of line-item disputes and TeamHealth accounted for 15%, according to the Georgetown analysis of CMS’ data. The report also found that the top five provider organizations collectively filed 59% of all arbitration disputes.
CASMB continues to urge the Trump administration and Congress to implement common-sense reforms to address current flaws in the arbitration process.
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