As litigation efforts continue to target the patient protections in the No Surprises Act (NSA), nearly 60 organizations representing patients, consumers, labor unions, and employers have come together in a letter to the tri-agencies emphasizing the need to stand firmly with patients and consumers in future rulemaking and implementation of the law. Despite recent research showing the No Surprises Act prevented 9 million surprise bills in the first 9 months of 2022, certain provider and hospital groups continue to file lawsuits fighting the regulations, including most recently the Texas Medical Association and air ambulance provider LifeNet.
In the letter, the organizations call for the Departments of Health and Human Services, Treasury, and Labor to stand strong in the face of continued litigation. The signatories highlight the strategy being used by providers and certain private equity-backed groups to abuse the Independent Dispute Resolution (IDR) process and intentionally over-file claims, resulting in increased health care costs for patients. As a bipartisan majority of voters continue to be concerned about attempts to overturn the patient protections included in the No Surprises Act, these litigation efforts are clearly an attempt by certain providers to put profits over patients. It is essential the Administration stay the course and ensure the NSA actually lowers health care costs as Congress intended.
Highlights from the letter include:
- “Recent analysis estimates bipartisan enactment of the NSA prevented 9 million surprise medical bills in the first 9 months of 2022. Unfortunately, despite this tremendous success, the Texas Medical Association recently filed another federal lawsuit challenging your Departments’ NSA rulemaking, its third such lawsuit in the past year, following a suit in September to vacate parts of the August 2022 Final Rule, “Requirements Related to Surprise Billing.””
- “The non-partisan Congressional Budget Office estimated the law would save the federal government $17 billion over 10 years and that “in most affected markets in most years, smaller payments to some providers would reduce premiums by between 0.5 percent and 1 percent”. It is clear there is now an ongoing effort to erode these savings at the expense of consumers, employers, unions, and taxpayers.”
- “Now that surprise billing is prohibited, it is clear the new profit strategy for some provider and hospital groups is to challenge every claim possible through IDR while making IDR outcomes so unpredictable and unbound to market rates they can recoup excessive payments approaching billed charges. This volume and unpredictability are not sustainable for the government, the IDR Entities, or the public that will bear the cost of frequent disputes and unreasonable payments.”
- “The health care system cannot bear the level of IDR claims too many providers and hospitals seek. Already this year, we have seen nearly nine times as many IDR requests than the Departments predicted a year ago. Recent AHIP/BCBSA survey data suggests providers are on track to submit more than 275,000 claims to IDR – a staggering figure that indicates providers and private equity firms see financial opportunity in arbitration. Fully 24% of the claims filed were not eligible for federal arbitration, which evidences the providers’ strategy to overwhelm the IDR process.”
To view the full letter, click here.