- Docket No.
- 26-12777
- Appellate Court
- Eleventh Circuit
Goal
- Award restitution
- Declaration that awards are enforceable
- Declaration that defendants’ actions are unlawful
- Vacate arbitration awards
Issues
Case History
Litigation Content
Why This Matters:
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. On appeal, the plaintiff argues that the district court erred in granting the defendants’ motion to dismiss.
Potential Impact:
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.