AMA, AHA move to dismiss surprise billing rule lawsuit but hint at future moves

The American Hospital Association and American Medical Association dismissed their lawsuit challenging the Biden administration’s surprise billing rule but cautioned more litigation could be on the way. 

The two medical advocacy groups announced in a legal filing on Tuesday that the lawsuit challenging the rule was moot after a new final rule was released by the Biden administration last month. Even though the groups dismissed the lawsuit, they charged the newest regulation still favors insurers too much. 

“We have serious concerns that the August 2022 final rule departs from Congressional intent just as the September 2021 interim final rule did,” the groups said in a joint statement Tuesday. 

The new legal threat is the latest response from providers who have been dismayed at how the administration has implemented the No Surprises Act, a law that bans surprise medical bills and calls for an arbitration process to handle disputes over an out-of-network charge.

AHA and AMA charged that the Sept. 2021 rule was too favorable for insurers in the implementation of an arbitration process for handling the disputes. The law called for both insurers and providers to submit their own amounts for the out-of-network charge and a third party chooses one. 

However, the Sept. 2021 rule said that the arbiter must put a heavy emphasis on choosing the figure closest to a qualifying payment amount, which is the geographic price average for a service.

AHA and AMA said in their lawsuit filed in Dec. 2021 that the rule doesn’t follow the law where Congress explicitly did not include a benchmark rate in the arbitration process. 

The Texas Medical Association also filed a similar lawsuit and in February a federal judge struck down the arbitration process. Health and Human Services had pledged to appeal the ruling.

The administration responded by issuing a new rule last month making changes to the arbitration process. It ditches the requirement that the arbiter place a heavy emphasis on the qualifying payment amount and instead calls for other factors to have more equal weight.

The new rule earned plaudits from patient advocacy groups such as Families USA, which said last month that it will help to “discourage abuse of the reimbursement negotiations process.” However, the AHA and AMA still have concerns about the rule and hinted at its next steps. 

“Hospitals and doctors intend to make our voices heard in the courts very soon about these continued problems,” the groups said in the joint statement.