February 24, 2022

Texas Medical Association Federal Surprise Billing Lawsuit Win Protects Patients and Providers

The U.S. District Court for the Eastern District of Texas ruled Feb. 23, that the insurer-provider payment arbitration process in the federal Surprise Billing Interim Final Rule violates the Administrative Procedure Act.

“The court’s sensible ruling is a win for patients and providers,” said Howard B. Fleishon, MD, MMM, FACR, Chair of the American College of Radiology® (ACR®) Board of Chancellors. “Insurers are already using the law’s mis-implementation to raise profits by narrowing provider networks, which can strip patients of access to their chosen providers, reduce overall access to care, and delay diagnosis and treatment of illness and injury.

“This victory impacts only the insurer-provider payment dispute process in the final rule. It does not affect the law’s patient protections or raise patient out-of-pocket costs. The ruling can only benefit patients by helping to ensure that they continue to have access to their chosen providers in their communities.

“Although this case is separate from that filed against the federal government by the ACR, the American Society of Anesthesiologists and the American College of Emergency Physicians, we hope this ruling is the first of a series of decisions that will force the agencies to implement the No Surprises Act exactly as Congress intended.”

The court’s decision does apply nationally. However, the government may appeal and also may request a stay in the court’s order, pending resolution on appeal. It is unclear how this will affect our lawsuit or the rule’s implementation but, for now, the offending provisions of the rule are vacated.

More information about the ACR, ACEP and ASA lawsuit is on the College’s website.

If you have questions, contact Tom Hoffman, ACR Vice President, Legal.