National Health Insurers vs. Anesthesiology Practices: ASA Weighs in on No Surprises Act Dispute

CHICAGO — The American Society of Anesthesiologists (ASA) filed an amicus curiae “friend of the court” brief this week in the U.S. District Court for the Eastern District of Pennsylvania in support of NorthStar Anesthesia, which is facing a lawsuit brought by UnitedHealthcare regarding the independent dispute resolution (IDR) process established in the No Surprises Act (NSA).   

In the brief, ASA urged the court to dismiss UnitedHealthcare’s fraud claims, warning that allowing insurers to pursue fraud allegations based on disputed IDR eligibility determinations undermines the administrative framework Congress created in the NSA, which could open the door to massive moneyed national health insurance companies suing local medical practices.

Eligibility determinations under the IDR process are legally complex and frequently disputed, ASA explained, noting it is not unusual for there to be confusion around the eligibility of a dispute claim. According to ASA, this demonstrates that honest mistakes are common and inevitable, not evidence of fraud.

Determining whether a claim qualifies for IDR is a question of law, not fact, according to ASA’s brief, and consequently cannot support common‑law fraud claims. ASA explained that IDR entities are required to use independent judgment when assessing eligibility and do not rely on either party’s legal assertions.

Anesthesiologists also face significant challenges in obtaining complete and accurate insurance information, noted ASA. Anesthesiologists must often rely on incomplete information from health insurers when determining eligibility for IDR. ASA has urged federal regulators to require insurers to provide clearer and more complete data to reduce confusion and administrative waste.

ASA’s brief also pointed to an existing administrative remedy established by the Centers for Medicare & Medicaid Services (CMS) that allows IDR decisions to be reopened when eligibility errors are identified. ASA argued that this process—rather than fraud litigation—is the mechanism that should be used for addressing disputed eligibility determinations.

“Congress deliberately designed the No Surprises Act to be enforced through a comprehensive administrative framework,” ASA wrote, cautioning that allowing insurers to bypass that framework through fraud lawsuits will destabilize the IDR system and threaten patient access to care.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 60,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during, and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Follow ASA on Facebook, X, Instagram, Bluesky, and LinkedIn.

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