In The New York Times, the headline was “Trump Administration Says Surprise Billing Law Is Being ‘Gamed’ by Doctors.” In The Wall Street Journal, it was “Medical Billing Arbitration Paid Out $15 Billion to Providers in Surprise Bill Disputes.” In STAT, it was “This spine surgery usually costs $1,400. Under No Surprises Act arbitration? $34,000.” The Washington Examiner editorial board said “Congress must fix its No Surprises mistake.”
Last night, The Wall Street Journal editorial board delivered the next damning IDR headline — “The ‘Surprise Billing’ Racket” — detailing how the arbitration system that federal officials projected would handle 17,000 disputes a year instead generated more than 6 million disputes since 2022, with arbitrators ruling in favor of providers in nearly 90% of cases. Large provider groups — many backed by the same entities that built surprise billing business models to exploit patients — are winning payments three to nine times in-network rates. The latest CMS data released this week found that nearly $15 billion in IDR payouts went to providers in 2025 alone, a 275% increase from 2024. The pattern of abuse is impossible to ignore.
To view the full editorial, click here. Highlights are included below (emphasis added):
- “Congress measures success by what it passes, not by the results of what it passes. A classic example is the No Surprises Act of 2020, which has had consequences nearly the opposite of what was intended.”
- “Arbitrators last year ruled in favor of providers in nearly 90% of cases. Large provider groups on average win payments that are three to nine times in-network rates. One reason is that they can choose which CMS-certified arbitration company reviews their claims. No surprise, they funnel claims to those that rule in their favor.”
- “Arbitrators also have a strong incentive to rule for providers to attract more business. Arbitrators set their fees—typically about $600 per claim—which are paid by the losing party. Ruling for providers encourages them to file more claims. No surprise, claims have exploded.”
- “Insurers have challenged about 40% of claims by providers as ineligible for arbitration under the no surprise law, usually because they involve elective procedures. But arbitrators don’t often throw out ineligible claims. Why not? Because they don’t get paid unless they issue a payment determination.”
- “Providers are winning huge payouts for ineligible claims, which encourages them to file more claims seeking bigger payments. The riches that can be made have discouraged providers from joining insurer networks, which ironically was one of the surprise billing law’s goals.”
- “Planned procedures—not emergencies that the law was designed to address—account for the bulk of insurer payouts. Elevance says plastic surgeons seek $100,000 on average for breast reduction surgeries, while its in-network providers are paid $2,000 to $5,000 on average. Medicare pays only $1,500. One Connecticut practice is obtaining awards of roughly $440,000 for the procedure.”
- “A lucrative cottage industry has developed around this system. Medical billing companies—the most prominent is HaloMD—submit claims on behalf of providers and take a cut of provider awards. The owners of HaloMD also run a neuro-monitoring service.”
- “Private-equity firms own some of the top billing providers, including TeamHealth, SCP Health and Radiology Partners. They also are financing arbitration companies.”
One after another, the nation’s leading media outlets have reached the same conclusion: the No Surprises Act’s IDR process is being systematically gamed by certain private equity-backed providers and IDR middlemen. Employers and millions of Americans are paying the cost. It’s past time for policymakers to act.
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