Big win for physicians on No Surprises Act implementation
By Jeff Scott, Esq., FMA General Counsel  |  Updated February 24, 2022

In a major victory for medicine, a United States District Court Judge yesterday issued a ruling setting aside certain portions of the controversial Sept. 2021 interim final rule implementing the federal No Surprises Act. The interim final rule has been challenged in multiple venues as giving insurance companies an unfair advantage over physicians in the arbitration process established in the No Surprises Act. In this challenge from the Eastern District of Texas, the court held that:

  • Physicians have standing to challenge the interim final rule.
  • The interim final rule conflicts with the unambiguous terms of the No Surprises Act; and
  • The Departments that issued the rule improperly bypassed notice and comment requirements.

The court found that the provision in the rule establishing a rebuttable presumption in favor of the insurer-determined qualified payment amount effectively “rewrites clear statutory terms” and was unlawful on this basis alone. The court vacated the offensive portions of the rule while leaving the rule as a whole intact. Read the court’s opinion here. FMA members who need more information can contact our General Counsel’s office at jscott@flmedical.org.