Since the No Surprises Act (NSA) was implemented, several lawsuits have challenged how the federal government has interpreted the law. Most recently, on August 2, 2024, the U.S. Fifth Circuit Court of Appeals delivered a significant win for physicians in the Texas Medical Association (TMA) II case. The court found that the Departments of Health and Human Services, Treasury, and Labor (the Departments) overstepped their authority by creating rules that unfairly favored insurance companies in the independent dispute resolution (IDR) process. Specifically, the court ruled that requiring arbitrators to prioritize the Qualifying Payment Amount (QPA) over other factors violated the NSA’s requirement that all factors be considered equally.  

This ruling is especially important because it is one of the first to interpret healthcare regulations after the reversal of the Chevron Deference doctrine. The Fifth Circuit reinforced the lower court’s decision to void these rules nationwide, highlighting the need for consistency in the IDR process. By rejecting the Departments’ attempt to limit arbitrators’ discretion, the court emphasized the importance of following the guidelines set by Congress, not allowing agencies to exceed their authority.  

Looking ahead, this decision will have a big impact on the business of healthcare. With TMA III set for oral arguments in September, the litigation over the NSA is far from over. Physicians involved in the IDR process should stay informed as these cases will shape future reimbursement practices. To dive deeper into this case and stay informed on future NSA litigation, listen to our latest episode of Zotec Answers and subscribe for future updates.