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VerdictCONSULTING GROUP

Can a health plan challenge an IDR award in court?

Verdict Consulting Group Research · Updated

Answer

Only on narrow grounds. An IDR determination is binding and not subject to judicial review except in the four situations listed in Federal Arbitration Act section 10(a): fraud, corruption or undue means; evident partiality; arbitrator misconduct; or an entity exceeding its powers. In 2026, district courts dismissed six payer suits under that limit and two for lack of jurisdiction.

Detail

The four FAA grounds

42 U.S.C. 300gg-111(c)(5)(E) makes an IDR determination binding "in the absence of a fraudulent claim or evidence of misrepresentation of facts" and bars judicial review except in a case described in paragraphs (1) through (4) of 9 U.S.C. 10(a):

ParagraphGround
10(a)(1)Award procured by corruption, fraud or undue means
10(a)(2)Evident partiality or corruption in the arbitrators
10(a)(3)Misconduct, such as refusing to hear pertinent and material evidence
10(a)(4)Arbitrators exceeded their powers

How courts apply it

In REACH Air Medical Services v. Kaiser (a published November 19, 2025 opinion), the Eleventh Circuit held that nothing in the No Surprises Act altered the FAA's limited scope of review, and affirmed dismissal of a provider's suit to vacate an award. Payer suits have fared the same way in 2026: see Payers are suing over IDR awards for the case-by-case table.

Correction (2026-10-10): An earlier version said courts dismissed five payer suits in 2026. Courts dismissed eight between April and September 2026: six under the NSA's limit on judicial review and two for lack of federal-question jurisdiction.

Read the analysis

Sources

  1. Legal Information Institute, Cornell Law School — 42 U.S. Code § 300gg-111 — Preventing surprise medical bills ()
  2. Legal Information Institute, Cornell Law School — 9 U.S. Code § 10 — Same; vacation; grounds; rehearing ()
  3. U.S. Court of Appeals for the Eleventh Circuit — REACH Air Medical Services LLC v. Kaiser Foundation Health Plan Inc., No. 24-10135 (11th Cir. Nov. 19, 2025) ()

General information only, not legal advice. Verdict Consulting Group is not a law firm.