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VerdictCONSULTING GROUP

Can a health plan vacate an IDR award for fraud?

Verdict Consulting Group Research · Updated

Answer

Only on narrow grounds, and courts have so far declined to vacate awards in payer suits. The statute permits judicial review only on the Federal Arbitration Act's section 10(a) grounds, including fraud. In April 2026, courts dismissed Anthem v. HaloMD and Aetna v. Radiology Partners, finding the alleged fraud was known to the payers during IDR.

Detail

The statutory standard

Under 42 U.S.C. 300gg-111(c)(5)(E), an IDR determination is binding "in the absence of a fraudulent claim or evidence of misrepresentation of facts presented to the IDR entity," and is not subject to judicial review except in a case described in paragraphs (1) through (4) of 9 U.S.C. 10(a). Fraud is ground (1).

What courts did in April 2026

CaseCourtRuling
Anthem Blue Cross v. HaloMDC.D. Cal.Dismissed without leave to amend, Apr. 9, 2026. Anthem alleged false eligibility attestations but had objected to eligibility in IDR; the court said it had "pleaded itself out of court" on fraud.
Aetna Health v. Radiology PartnersM.D. Fla.Dismissed with prejudice, Apr. 16, 2026. Fraud was adequately pleaded, but Aetna's own allegations showed it knew of the conduct before IDR; remaining claims preempted.

The O'Neill Institute reports that Anthem appealed to the Ninth Circuit. Later 2026 dismissals of payer suits in Texas and Georgia are covered in Payers are suing over IDR awards.

Correction (2026-10-10): An earlier version said Aetna's fraud allegations "had not been raised in IDR" and gave an April 14, 2026 date for Anthem's notice of appeal. The court held the alleged fraud was discoverable before or during IDR; we could not verify the appeal date and have removed it.

Read the analysis

Sources

  1. Legal Information Institute, Cornell Law School — 42 U.S. Code § 300gg-111 — Preventing surprise medical bills ()
  2. U.S. District Court for the Central District of California (court filing hosted by the O'Neill Institute) — Anthem Blue Cross Life & Health Insurance Co. v. HaloMD LLC, No. 8:25-cv-01467-KES (C.D. Cal. Apr. 9, 2026), memorandum opinion and order (Ex. A to notice filed in N.D. Ga. No. 1:25-cv-02919) ()
  3. U.S. District Court for the Middle District of Florida (court filing hosted by the O'Neill Institute) — Aetna Health Inc. v. Radiology Partners, Inc., No. 3:24-cv-1343-BJD-LLL (M.D. Fla. Apr. 16, 2026), order ()
  4. O'Neill Institute, Georgetown Law — California court issues first decision in insurer lawsuits under the No Surprises Act ()

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