What did the Texas Medical Association v. HHS cases decide?
Verdict Consulting Group Research · Updated
Answer
The Texas Medical Association v. HHS cases struck down federal rules that favored the QPA in IDR. Courts vacated the QPA presumption in 2022, later QPA-weighting rules in 2023 (affirmed in 2024), and the 2023 fee increase and batching rules. In August 2026 the en banc Fifth Circuit held that QPAs cannot include ghost rates.
Detail
The four cases
Numbering follows the Departments' usage in 91 FR 33900. The Fifth Circuit's 2024 opinion numbers the third and fourth cases in reverse.
| Case | Court | What was challenged | Outcome |
|---|---|---|---|
| TMA I, 587 F. Supp. 3d 528 | E.D. Tex. (2022) | Rebuttable presumption that the QPA is the appropriate payment amount (October 2021 interim final rule) | Vacated; government appeal voluntarily dismissed |
| TMA II, 654 F. Supp. 3d 575 | E.D. Tex. (2023); 5th Cir. No. 23-40217 | August 2022 final rule provisions directing IDR entities how to weigh the QPA | Vacated; affirmed Aug. 2, 2024 |
| TMA III, No. 6:22-cv-450 | E.D. Tex. (Aug. 24, 2023); 5th Cir. No. 23-40605 | QPA methodology: ghost rates, incentive payments, single-case agreements | Mostly vacated; en banc Aug. 11, 2026 affirmed in part, reversed in part |
| TMA IV, No. 6:23-cv-59 | E.D. Tex. (Aug. 3, 2023) | $350 administrative fee guidance and batching provisions | Vacated; not appealed |
Effect on the IDR process
The Departments state in the 2026 Federal IDR Operations rule that these rulings "necessitated multiple temporary shutdowns of the Federal IDR process" (91 FR 33902). For a fuller history, see How did the TMA lawsuits reshape the federal IDR process, 2022–2026?.
Read the analysis
Sources
- U.S. Court of Appeals for the Fifth Circuit — Texas Medical Association v. HHS, No. 23-40217 (5th Cir. Aug. 2, 2024) ()
- U.S. Court of Appeals for the Fifth Circuit — Texas Medical Association v. HHS, No. 23-40605 (5th Cir. Aug. 11, 2026) (en banc) ()
- Federal Register — Federal Independent Dispute Resolution Operations, 91 FR 33900 ()
General information only, not legal advice. Verdict Consulting Group is not a law firm.