Dive Brief:
- A federal judge has tossed out another lawsuit against billing intermediary HaloMD for allegedly gaming the process set up by the No Surprises Act to determine payment for out-of-network claims.
- Blue Cross Blue Shield Healthcare Plan of Georgia, which operates under Elevance’s Anthem brand, sued the company and two provider groups last year, arguing they flooded the system with ineligible disputes to fraudulently receive higher reimbursement from payers.
- But a judge in Georgia’s northern district court ruled in HaloMD’s favor on Friday, marking the third recent dismissal against the company after lawsuits failed in California and Texas. An Elevance spokesperson said the insurer plans to appeal the decision.
Dive Insight:
The lawsuit is another salvo between providers and payers over the arbitration system created by the No Surprises Act, a law passed six years ago to protect patients from surprise out-of-network medical bills.
The Independent Dispute Resolution process, which began in 2022, allows providers and insurers to both submit what they consider a fair price for care, before an independent arbiter certified by the government chooses one of the offers.
But the arbitration system has been plagued by complaints from both insurers and providers, which both argue the process unfairly benefits the other side. Insurers have been particularly vocal, citing evidence that providers are filing significantly more disputes than regulators originally anticipated and that they’re winning the vast majority of contests.
The research suggests that certain providers are leaning on the arbitration process in order to profit, insurers allege. Just a few groups initiate an outsized chunk of disputes: HaloMD, along with private equity-backed medical groups Team Health and SCP Health, accounted for about 44% of the disputes in the first half of 2025, according to CMS data.
HaloMD has also been at the center of several recent lawsuits from payers. In the Georgia case, Elevance accused HaloMD and two Georgia medical groups of fraudulently submitting thousands of ineligible surprise billing disputes — including challenges that were already resolved or claims for services that weren’t covered by the patient’s plan.
The flood of disputes was aimed at confusing and overwhelming arbiters, and meant to result in inflated reimbursement from payers, Elevance said.
But a federal judge dismissed the case brought by the insurer last week, determining Elevance’s claims that the plaintiffs violated racketeering laws are outside of the court’s jurisdiction, because it would require the court to second-guess the decisions of No Surprises arbiters.
The insurer’s allegations that HaloMD had broken the Employee Retirement Income Security Act and a state defective trade practices law are outside the court’s purview too, District Judge Thomas Thrash Jr. ruled.
“For the Court to provide injunctive relief to the Plaintiff under ERISA, the Court must review whether the Defendants previously complied with the requirements of the IDR process and determine whether specific items and services were actually eligible for IDR, something that has already been done by the [arbiter] before making the payment determination in each case,” he wrote in the order.
Elevance said it disagreed with the court’s ruling. The decision “misinterprets the No Surprises Act and improperly limits judicial review” of allegations that providers and billing companies are taking advantage of the dispute resolution process, a spokesperson said in a statement to Healthcare Dive.
HaloMD cheered the decision, arguing insurers’ lawsuits against the company were designed to intimidate providers and bully them into accepting low reimbursements.
“These cases were never about HaloMD,” Alla LaRoque, president of HaloMD, said in a statement Monday. “It was part of a broader effort to convince the courts and Congress that provider success in IDR must mean the system is broken. Today, the Court rejected that premise.”
