Doctor, hospital lobbies move to dismiss lawsuit over surprise billing ban


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The American Medical Association and American Hospital Association are trying to dismiss their own lawsuit against the federal government over implementation of the No Surprises Act.

The two lobby groups filed a motion to dismiss their claims in federal court on Tuesday, along with joint plaintiffs Renown Health, UMass Memorial Health Care and doctors Stuart Squires and Victor Kubit. The request comes ahead of a status hearing on Wednesday.

The groups filed suit over the temporary filing rule that was released last year.

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In their original complaint, the AMA and AHA said they did not challenge the 2020 law banning surprise medical bills passed by Congress. Instead, they questioned how the federal government implemented the law through the rulemaking process, claiming it deviated from Congress’ original intent and putting “a hard thumb on the scales” favoring insurers during the independent arbitration process.

Lobby groups believe the lawsuit became moot when the final rule on surprise billing was released last month, though the two said the final rule still deviated from Congress’ original intent.

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However, the two lobby groups have hinted that despite their attempt to dismiss their claims, another lawsuit may be underway.

The No Surprises Act exempts patients from payment disputes by establishing a mechanism for payers and providers to resolve disputes through arbitration.

To provide referees with guidance on payment considerations when making rules, CMS places weight on the qualifying payment amount, or the median in-network rate, for a given service in a given region.

The interim final rule instructed the umpires that they “must begin with the assumption that the [qualifying payment amount] is the appropriate [out-of-network] quantity.” It is this directive that has led to a pushback from vendors.

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The QPA effectively caps prices, former AMA President Gerald Harmon told Healthcare Dive.

The final rule, released last month, overturns this controversial language.

“Hospitals and doctors intend to raise our voices in court on these ongoing issues very soon,” the two said in a joint statement provided to Healthcare Dive.

The case is currently with Judge Richard Leon of Columbia District Court and has been consolidated into one case with the Association of Air Medical Services.



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