'Major victory': Texas physicians score key court win in national fight over surprise billing ban
Physicians scored a “major victory” in court Wednesday, with a federal judge striking down one radiologist-opposed provision in regulation banning surprise medical bills.
The U.S. District Court has granted a request for summary judgment in the Texas Medical Association’s ongoing lawsuit against the Biden administration. Judge Jeremy Kernodle agreed that the dispute-resolution process detailed in the surprise billing final rule violates the Administrative Procedure Act, governing the process by which federal agencies develop and issue regulations.
“This decision is a major victory for patients and physicians,” Diana Fite, MD, immediate past president of the Texas Medical Association, said Feb. 23. “It also is a reminder that federal agencies must adopt regulations in accordance with the law.”
Texas docs sued the feds in October, charging that the administration failed to follow congressional intent in its interim final rule, spelling out how to settle quarrels over out-of-network payments. Lawmakers had recommended a robust dispute-resolution process that took several factors into account. But the medical association believes the final rule placed too much emphasis on the “qualifying payment amount,” set solely by health insurers. Several other medical groups have since filed similar suits, including the American College of Radiology in December.
ACR applauded the Eastern Texas District Court judge’s “sensible ruling,” noting that insurers have already been using the “mis-implementation” of the law to raise profits by narrowing provider networks. The decision only affects the payer-provider dispute-resolution process and not other provisions that protect patients from surprise medical bills, ACR Board of Chancellors Chair Howard Fleishon, MD, noted.
“Although this case is separate from [the lawsuit] 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,” he said in a Feb. 24 statement.
ACR also emphasized that Judge Kernodle’s order does apply nationally, but the federal government can still 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,” the college said in its update.
The American Medical Association—which filed its own separate lawsuit alongside the American Hospital Association and others—also voiced its support for the Texas decision on Thursday.
Meanwhile, AHIP, the nation’s largest trade association for health insurance companies, slammed the ruling Wednesday. It charged that private equity-backed providers and others who have “long profited” from sending surprise bills are now “doing everything they can” to protect their earnings. President and CEO Matt Eyles called the court’s ruling “misguided” and claimed it will result in higher healthcare costs and premiums.
“It is unconscionable for providers to fight to weaken protections for patients who deserve to be protected from surprise medical bills, and to exploit the arbitration process to pad their bottom lines,” he said in a statement. “AHIP continues to fully support the administration in its defense of the No Surprises Act and the interim final rule, and we will continue to support the government’s defense of the rules in other courts.”
Editor's note: This item has been corrected to say the ACR emphasized that the order DOES apply nationally. Radiology Business regrets this error.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.