Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. v. HaloMD, LLC et al.

Docket No.
1:25-cv-02919
District Court
Georgia Northern

Goal

  • Award restitution
  • Declaration that awards are enforceable
  • Declaration that defendants’ actions are unlawful
  • Vacate arbitration awards

Issues

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 Georgia RICO statute, the Georgia Deceptive Trade Practices Act, and the Employee Retirement Income Security Act. 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.

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Related Litigation

Current Status

Briefing is ongoing

Legal Issues

Racketeer Influenced and Corrupt Organizations (“RICO”) Act, Georgia RICO Statute, Fraud/Fraudulent Misrepresentation, Negligent Misrepresentation, Statutory Fraud, Theft By Deception (Georgia Law), Civil Conspiracy, Georgia Deceptive Trade Practices Act, Employee Retirement Income Security Act

Topic(s)

Arbitration Awards/Conduct

Date Filed
May 27, 2025
Case Type
Civil
Court Type
District Court
Court
Georgia Northern
Judge
Thrash, Thomas W., Jr. Appointed By: William J. Clinton
Plaintiff(s)
Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.
Lead Counsel For Plaintiff(s)
Balch & Bingham, LLP et al.
Defendant(s)
HaloMD, LLC; Hospitalist Medicine Physicians of Georgia – TCG, PC; Hospitalist Medicine Physicians of Georgia – TCS, PC (Dismissed); Sound Physicians Emergency Medicine of Georgia, P.C.
Lead Counsel for Defendant(s)
Polsinelli PC et al.