Anthem Health Plans of Virginia Inc. et al. v. AGS Health Inc. et al

Docket No.
7:25-cv-00804
District Court
Virginia Western

Goal

  • Award damages
  • Award restitution
  • Block defendant action
  • Declaration that defendants’ actions are unlawful
  • Vacate arbitration awards

Issues

Potential Impact:

Why this Matters:

The plaintiffs allege that providers and their third-party vendors are abusing the No Surprises Act arbitration process to receive higher out-of-network payments in violation of the federal Racketeering Influenced and Corrupt Organizations (“RICO”) Act, the Employee Retirement Income Security Act, and Virginia law. The higher than expected volume of arbitration cases (including the prevalence of ineligible cases) 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.

News And Analysis (2)

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Related Litigation

Current Status

Briefing is ongoing

Legal Issues

Racketeering Influenced and Corrupt Organizations (“RICO”) Act, Conspiracy to Violate RICO Act, Virginia State Law, Fraudulent Misrepresentation, Constructive Fraud, Civil Conspiracy, Conversion, Employee Retirement Income Security Act

Topic(s)

Arbitration Awards/Conduct

Date Filed
November 5, 2025
Case Type
Civil
Court Type
District Court
Court
Virginia Western
Judge
Ballou, Robert S. Appointed By: Joseph R. Biden Jr.
Plaintiff(s)
Anthem Health Plans of Virginia Inc.; Healthkeepers, Inc.
Lead Counsel For Plaintiff(s)
Crowell & Moring LLP
Defendant(s)
AGS Health, Inc.; The Schumacher Group of Louisiana, Inc.; Ingleside Emergency Group, LLC; Kingsford Emergency Group, LLC; Lake Spring Emergency Group, LLC; Western Virginia Regional Emergency Physicians, LLC; Wildwood Emergency Group, LLC
Lead Counsel for Defendant(s)
Hancock Daniel & Johnson PC