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

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

Goal

  • Award damages
  • Declaration that certain arbitration awards are non-binding and not payable going forward
  • Overturn arbitration awards under the No Surprises Act
  • Prohibit Defendants from submitting unqualified arbitration cases or otherwise submitting improper arbitrations

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 Racketeering 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.

1 Major Filings

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