On Wednesday a case was filed in the Eastern District of Texas by Lifenet Inc. against the Department of Health and Human Services, the Department of Labor, the Department of the Treasury, the Office of Personnel Management and their respective heads. The case is regarding the No Surprises Act and billing for emergency medical flights.
The No Surprises Act was created to deal with situations where during emergency medical treatment, a patient can end up with an unexpectedly large medical bill. One provision of the No Surprises Act is the creation of an Independent Dispute Resolution process which allows an out of network provider of emergency medical services to obtain an order directing a certain minimum payment for the services from the patients health coverage. One portion of this process was a segment imposing a “Qualifying Payment Amount” or QPA.
The plaintiff objects to this QPA because it has a presumption of correctness to which the plaintiff and similar plaintiffs have no input, and then shifts the burden of proving the necessity of extra charges to the plaintiff. The plaintiff notes that in a previous case, the court had “set aside the regulations’ QPA Presumption for two independent reasons: first, it “rewrites clear statutory terms” of the No Surprises Act…and second, it was promulgated without the notice-and-comment procedure that the APA requires…” However, HHS is still applying the QPA to other providers, the plaintiffs say.
Plaintiffs are suing, stating that the QPA should be set aside as arbitrary, capricious, and contrary to statute, as well as failing the required notice and comment provisions under the APA. Plaintiffs are represented by Susman Godfrey LLP.