Anthem Blue Cross Life and Health Insurance Company et al. v. HaloMD LLC et al.

Why this Matters:

A private insurer alleges that providers and their third-party biller are abusing the No Surprises Act arbitration process to receive higher out-of-network payments in violation of the federal Racketeer Influenced and Corrupt Organizations (“RICO”) Act, the Employee Retirement Income Security Act, and Section 17200 of the California Business and Professions Code. The higher than expected volume of arbitration cases (including the prevalence of ineligible cases) to date and high provider win rate could raise health costs and plan premiums.

Potential Impact:

Actions that flout the intent of the No Surprises Act arbitration process through the submission of ineligible disputes could lead to higher costs and lower-quality care for patients.