It’s no surprise that private equity-backed providers—including Nutex Health—have co-opted the No Surprises Act’s (NSA) IDR process into their go-to profit center. It’s the reason why private equity-backed championed arbitration as their “solution” to the surprise medical billing crisis they created. And now, a cost crisis in Idaho shows how widespread their abuse and misuse of IDR has become.
Nutex Health has made “exploiting a unique arbitrage model under the No Surprises Act” a core part of its business model. The company—based in Texas—recently opened its Post Falls ER & Hospital in Idaho and has since been financially leveraging its out-of-network status to intentionally flood the IDR process with exorbitant and extreme out-of-network disputes. Because IDR entities have been overwhelmingly favoring providers, Nutex continues to exploit the process that was supposed to be a “last resort” for its own financial gain.
As a new lawsuit in Texas alleges, since retaining HaloMD—one of the emerging IDR middlemen that have flooded the IDR process with exorbitant out-of-network disputes—Nutex:
- Funneled between 60 to 70 percent of its billable visits every month through arbitration;
- Reported “win rates” of more than 80 percent; and
- Attributed over 70 percent of annual revenue growth—amounting to nearly $170 million—in 2024 to arbitration.
The plaintiffs argue that Nutex and HaloMD staked their financials on increasing arbitration outcomes. “The central allegation in the complaint is that HaloMD, which has previously been the subject of payer lawsuits related to the provider utilization of the NSA’s IDR process, utilized tactics in the IDR process that amounted to a ‘scheme’ that misused the statutory framework to generate artificially-inflated revenue obtained via arbitration awards.”
Now, Nutex is seeking to expand its reach in Idaho by setting up another hospital near Boise.
The latest, as reported by the Idaho Statesman:
- “Nutex is routinely overcharging for treatment at its Post Falls hospital and possibly misusing a federal process designed to help providers and insurers settle out-of-network claims.”
- “Blue Cross of Idaho normally gets about 14 requests per month from providers seeking reimbursement through the independent-dispute process, about 170 per year. Now the Post Falls ER & Hospital sends roughly 75 requests per week…Over a six-month period starting in mid-April, that added up to roughly 2,800 requests.”
- “In one case, Blue Cross ‘received a claim for nasal congestion that was $2,872 to treat a runny nose…The median commercial rate is $376 for that service.’”
Read the full article from Idaho Statesman online here. Learn more about Nutex and HaloMD. For more on the $5 billion added costs from IDR that consumers and employers are paying, click here.
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