Can a provider sue to enforce an unpaid IDR award? Where the courts stand after the Second Circuit

Where courts stand

The N.D. Ill. June 2026 decisions and Shareef Jandali are described in the Northern District of Illinois's August 5, 2026 opinion, which collects the cases; Axis Neuromonitoring is cited in the Second Circuit's opinion. No circuit split exists: the two courts of appeals to decide the question agree, and the disagreement is among district courts. Because the Second Circuit's decision binds district courts in Connecticut, it effectively abrogates the implied-right holding of Guardian Flight v. Aetna. Agag is different: it confirmed $142,567.99 in awards without finding an implied right, and Cigna's appeal is pending.

What the district courts disagree about

The statute says an IDR determination "shall be binding upon the parties involved" and that payment is due within 30 days (42 U.S.C. 300gg-111(c)(5)(E), (c)(6)). It contains no express cause of action.

• No private right. The Fifth and Second Circuits, and the Pennsylvania and Illinois district courts, rely on the Act's cross-reference to FAA vacatur but not FAA confirmation, and on the Departments' enforcement authority, including civil money penalties, as the remedy Congress chose.
• Narrow implied right. The District of Maryland held that the Act "impliedly authorizes a very narrow private right of action to convert a 'binding' IDR determination to a judgment" when the obligated party does not pay.

The open question: confirmation suits

The Second Circuit did not hold that providers can never go to court over an unpaid award. In footnote 13 it declined to decide Cigna's argument that the Act's bar on "judicial review" also forecloses suits to confirm awards ("We need not decide this issue"), assuming without deciding that the bar did not block the provider's suit. The Agag appeal (No. 26-1241) may answer whether a confirmation suit survives in the Second Circuit. In the Seventh Circuit, consolidated appeals from the Northern District of Illinois could make it the third circuit to decide the enforcement question.

Related vacatur rulings

Payer suits to set aside awards raise a different question: whether a court may review an award at all. In REACH Air Medical Services v. Kaiser (11th Cir. Nov. 19, 2025), the court affirmed dismissal of a provider's vacatur suit, holding that the Act did not alter the FAA's narrow review. District courts applied the same standard to dismiss payer suits in April 2026, including Anthem Blue Cross v. HaloMD and Aetna Health v. Radiology Partners.

Correction (2026-10-10): An earlier version listed the Eleventh Circuit as holding there is no private right to enforce awards; REACH concerned vacatur, not enforcement. It also showed the Second Circuit case as pending; the court decided it on September 17, 2026. We added the Northern District of Illinois and later District of Connecticut decisions and removed general advice to readers.

Correction (2026-10-10): We retitled this article, which previously described a circuit split; the Fifth and Second Circuits agree, and the disagreement is among district courts. We corrected the Agag v. Cigna date (April 15, 2026, not March 15) and its holding: the court dismissed the NSA damages and FAA claims and confirmed the awards without finding an implied right. We also noted that the Second Circuit's decision effectively abrogates Guardian Flight v. Aetna and leaves open whether confirmation suits are barred.