United States of America

5th Circuit Strikes Down Surprise Billing Rules

Did this protect patients from rigged surprise billing or did it gut the framework to protect them?

4 hours ago·Updated 1 hour ago

5th Circuit Strikes Down Surprise Billing Rules

Story

Above: The John Minor Wisdom U.S. Court of Appeals Building in New Orleans, Louisiana, on April 28. Image credit: Marcus Jones/Getty Images

The Spin

Narrative A

Federal agencies don't get to rig the math and without facing legal consequences. Including ghost rates that providers never negotiated and never used artificially tanked the QPA, and the numbers prove it: arbitrators picked a rate higher than the QPA in 85% of cases. Agencies can't bypass notice-and-comment, botch the rule, then patch it with an informal FAQ and expect courts to look the other way.

United States Court of Appeals for the Fifth Circuit

Narrative B

Striking down these QPA rules threatens the entire framework Congress built to protect patients from surprise billing. The agencies reasonably based calculations on contracted rates as they existed, focusing on what was contracted, not how often a service was billed. Vacating the methodology wholesale, rather than remanding, creates massive disruption and ultimately pushes higher costs onto patients.

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