On August 2, 2024, the United States Court of Appeals for the Fifth Circuit affirmed a district court’s ruling 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. Department of Health and Human Services, No 23-40217 (5th Cir. Aug. 2, 2024). 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 Friday’s decision, the Fifth Circuit held that the federal departments implementing the NSA exceeded their statutory authority by issuing “extrastatutory” procedural rules governing the NSA’s dispute-resolution process. The Fifth Circuit also upheld the district court’s decision to universally vacate the challenged rules, reaffirming that TMA properly secured nationwide relief for physicians and other healthcare providers.
In the three years since the federal government began taking steps to implement the NSA, Sidley has represented TMA in four lawsuits successfully challenging regulations that both diminish physician and hospital reimbursements for claims subject to the NSA and make it more challenging to access the arbitration process. With Friday’s ruling, TMA adds an appellate win to its undefeated record in the district court. 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, and Cody Akins. Eric McArthur argued the case before the Fifth Circuit.
