WASHINGTON – The ERISA Industry Committee (ERIC) and coalition allies filed an amicus brief with the U.S. Court of Appeals for the Ninth Circuit in Anthem Blue Cross Life and Health Insurance Company v. HaloMD, LLC. The brief asks the court to reverse a district court ruling that stripped health plans of the ability to challenge fraudulent or ineligible claims filed under the Independent Dispute Resolution (IDR) process established by the No Surprises Act (NSA).
ERIC’s brief points out that this leaves employer plans with no way to stop bad actors from extracting improper or inflated payments, costs ultimately inflicted on workers through higher premiums and reduced benefits.
“Employer health plans should be able to sue bad actors that are abusing the IDR process that Congress designed to reduce the cost of healthcare. These parties are using the process to inflate costs by filing improper claims,” said Doug Hinson, Executive Director of the ERIC Legal Center. “The district court’s ruling cuts off the only recourse plans have left. If this decision stands, the companies gaming this system will continue to escalate the costs of healthcare for their own profit.”
Congress passed the NSA to shield patients from surprise medical bills and lower health care costs. Its IDR process was expected to handle about 17,000 disputes a year. Instead, providers and the billing companies that represent them have filed nearly 4.8 million disputes since the law took effect, and the brief argues the process has become a profit center for a small number of high-volume filers rather than a backstop for patients.
The brief argues that HaloMD is abusing the law. Disputes it filed resulted in awards averaging more than nine times what insurers pay in-network providers for the same services, and together with two other companies, it accounted for nearly half of all disputes filed in the first half of 2025. Health plans flagged close to 40 percent of disputes as ineligible for arbitration in 2024, but arbitrators dismissed only a small fraction of those claims. ERIC believes courts can and should hold those who are abusing the process responsible for their actions.
Read brief here.