In a new letter to the Secretaries of the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury, the Coalition Against Surprise Medical Billing (CASMB) urged prompt action on the “systemic cost challenges” stemming from the No Surprises Act’s Independent Dispute Resolution (IDR) process.
Since the law’s passage six years ago, a handful of bad actors – including private equity-backed provider groups and IDR middlemen – have systematically abused the IDR process, turning a tool designed to be a “last resort” into a profit engine that is only compounding the healthcare affordability crisis.
While the Centers for Medicare and Medicaid Services (CMS) initially estimated 17,000 cases would be filed per year, the latest data reports that over 6.3 million disputes have been filed since 2022 — nearly 370 times the original projection. The sheer volume of disputes flooding the system combined with the inflationary awards providers are winning — some of which reach upwards of 920% of the qualifying payment amount — has added more than $5 billion in estimated costs to the healthcare system in just two years. For American families, that translates directly to higher premiums, higher deductibles, and slower wage growth.
While the recent IDR operations final rule took steps to create greater transparency, several of its provisions will likely increase the number of submitted claims, further clogging and delaying the process. To protect patients and employers from rising costs, CASMB urges the administration to use its existing authority to implement three categories of commonsense reform:
- Rein in inflationary awards and runaway volume — that run counter to the law’s intent — by establishing clear guardrails ensuring IDR awards reflect market-based benchmarks, closing scope-of-services loopholes that allow scheduled and non-surprise care into the process, and requiring greater transparency and rationale in arbitration determinations.
- Stop bad-faith actors by automatically screening claims for eligibility through the IDR Gateway Portal before assigning an arbitrator and establishing upfront eligibility fees and meaningful penalties for providers with patterns of abuse.
- Enforce accountability for IDR entities (IDREs) by establishing performance metrics that hold arbitrators accountable to the administration and the public and strengthening conflict-of-interest standards so that IDREs — at least five of which are private equity-backed — are truly neutral and independent.
Consumers deserve a law that delivers on its promise of protecting patients and reducing healthcare costs. The administration has the authority to fix this, and CASMB is calling on it to do so.
You can read the full letter here. For more information on the No Surprises Act, visit: www.stopsurprisebillingnow.com
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