Texas Physicians Win In No Surprises Act Law Suit

Texas Physicians Win In No Surprises Act Law Suit

A  U.S. district court judge granted the Texas Medical Association’s motion for summary judgment agreeing that the Department of Health and Human Services (HHS) ’s interpretation of the No Surprises Act did not line up with the law, as written, and as Congress intended.

The ruling came on February 23, 2022. Judge Jeremy Kernodle concurred with the Texas physicians’ group wrote, “Rather than having an arbitrator consider all statutory factors as provided by the Act, Plaintiffs argue, the Rule puts a substantial thumb on the scale in favor of the QPA.” Later in his opinion, he stated that “the Act nowhere states that the QPA is the ‘primary’ or ‘most important’ factor.”

The Texas Medical Association brought a suit against the feds in October 2021, charging that HHS was not following the intent of the No Surprises Act passed by Congress — specifically over the disagreements on how to determine out-of-network payments.

The American College of Radiology (ACR) applauded the Eastern Texas District Court judge’s opinion. ACR underscored that the ruling applies to all states but that the federal government could appeal the decision.

The American Medical Association, who, in conjunction with the American Hospital Association and others, has filed a separate lawsuit, expressed their support of the Texas court’s decision.

Related lawsuits continue in other states as these areas wrestle with out-of-network payment agreements in their respective states.

Complicating the already muddied water even more, is the question over the states, including Texas, who already have surprise billings laws. At the University of Southern California Sol Price School of Public Policy, Glenn Melnick, Ph.D., reflects, “The question is, does the federal law supersede the state law?”

America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association filed an amicus brief supporting HHS and the No Surprises Act in January. AHIP called the Texas court’s decision “misguided” and will result in higher healthcare costs, including premiums for consumers.