For the Fourth Time, Sidley-Represented Physicians Prevail in No Surprises Act Challenge

On August 24, a district court in the Eastern District of Texas ruled in favor of a group of physicians and other healthcare providers, led by the Texas Medical Association (TMA), in a challenge to regulations implementing the No Surprises Act (NSA). See TMA v. United States Department of Health and Human Services, No. 22-cv-450 (E.D. Tex. Aug. 24, 2023). The NSA — the most significant legislation affecting commercial insurance markets since the Affordable Care Act — bars providers from balance billing patients for certain out-of-network services and channels decisions over provider reimbursement rates to a newly developed arbitration process.

In the two years since the federal government began taking steps to implement the NSA, Sidley has represented TMA in four lawsuits challenging regulations that both diminish physician and hospital reimbursement for claims subject to the NSA and make it more challenging to access the arbitration process. With yesterday’s ruling, TMA builds on another victory earlier this month, resulting in successful outcomes in all four of its cases. These decisions offer nationwide relief to physicians and other healthcare providers and will require the federal government to issue revised regulations relating to the NSA’s arbitration process.

This litigation was the product of a collaboration between Sidley’s Healthcare and Regulatory Litigation practice groups, including Jaime Jones, Brenna Jenny, Eric McArthur, Madeleine Joseph, Jillian Sheridan Stonecipher, Manuel Valle, Matthew Guillod, and Cody Akins.