Payers are suing over IDR awards: what do the 2025–2026 fraud and vacatur suits allege, and how have courts ruled?

What the suits allege

The payer suits share a pattern. Each targets a high-volume initiator of federal IDR disputes, or the providers it represents, and alleges that disputes were filed for items or services that were not eligible, with false attestations of eligibility.

• Anthem v. HaloMD (C.D. Cal.). Filed July 2025. Anthem alleged that HaloMD, affiliated practices and Sound Physicians entities submitted disputes they knew were ineligible, with false eligibility attestations. Claims included RICO, vacatur under FAA section 10(a)(1) and (4), ERISA and California law.
• Aetna v. Radiology Partners (M.D. Fla.). Aetna alleged that Radiology Partners routed other practices' claims through an out-of-network affiliate to obtain higher IDR awards, and sought vacatur, damages and an injunction.
• BCBS of Georgia v. HaloMD (N.D. Ga.). Alleged ineligible disputes, false attestations, high-volume filing and inflated offers; asserted federal and Georgia RICO, fraud, ERISA and vacatur claims.
• BCBS of Texas v. HaloMD and HCSC v. Zotec (E.D. Tex.). Fraud-based claims over federal and, in the HaloMD case, Texas IDR submissions.

Context from CMS: in the second half of 2025, the top three initiating parties (HaloMD, Team Health and SCP Health) accounted for about 38% of disputes, non-initiating parties challenged eligibility in 42% of disputes, and about 19% were found ineligible.

How courts have ruled

That is eight dismissals: six under the NSA's limit on judicial review (the first six rows) and two because a state-law fraud claim about IDR raised no federal question (E.D. Pa. and D. Hawaii). Appeals are reported by the O'Neill Institute.

The holdings, ground by ground

1. Review is limited to the FAA grounds. Under 42 U.S.C. 300gg-111(c)(5)(E), an IDR determination is not subject to judicial review except in the cases described in 9 U.S.C. 10(a)(1)–(4). The Eleventh Circuit, in a provider's vacatur suit, held that nothing in the Act altered that "limited scope of judicial review" (REACH Air Medical Services v. Kaiser, Nov. 19, 2025). The N.D. Ga. court held that "all other judicial review" is prohibited.

2. Fraud known during IDR does not support vacatur. The C.D. Cal. court held that because Anthem objected to eligibility in IDR, it had "pleaded itself out of court" on fraud: the alleged fraud was known and disclosed to the IDR entity. The M.D. Fla. court found Aetna's fraud adequately pleaded, but held that Aetna's own allegations showed the conduct was discoverable before IDR. The N.D. Ga. court reached the same conclusion.

3. Eligibility decisions are covered. Payers argued that the review bar covers only payment determinations. The C.D. Cal., N.D. Ga. and E.D. Tex. (Zotec) courts disagreed; the C.D. Cal. court reasoned that "an IDRE's payment determination necessarily includes a determination of eligibility."

4. Exceeding powers. Because regulations direct IDR entities to determine whether the federal process applies (45 CFR 149.510(c)(1)(v)), the C.D. Cal. court held that eligibility rulings fall within their assigned task and do not exceed their powers under section 10(a)(4).

5. Other theories are collateral attacks. RICO, ERISA and state-law claims were dismissed as attempts to relitigate IDR outcomes: as preempted (M.D. Fla.), as outside the court's jurisdiction under the Act and the collateral attack doctrine (E.D. Tex.), or as impermissible collateral attacks (N.D. Ga.). The E.D. Tex. court in BCBS of Texas v. HaloMD applied the Texas Insurance Code's similar limit to Texas IDR awards.

What to watch

Several appeals could produce the first appellate ruling on these arguments in a payer suit: Anthem v. HaloMD in the Ninth Circuit (No. 26-2355) and Aetna v. Radiology Partners in the Eleventh Circuit (No. 26-11607), where briefing is under way, along with the BCBS of Georgia v. HaloMD appeal to the Eleventh Circuit and the BCBS of Texas v. HaloMD appeal to the Fifth Circuit. The pending motion in Ohio will show whether another district follows.

Correction (2026-10-10): An earlier version said five district courts had dismissed payer suits and listed the Virginia suit as pending. As of September 30, 2026, courts had dismissed eight: six under the NSA's limit on judicial review, including the Western District of Virginia, and two for lack of federal-question jurisdiction. It also called the Ninth Circuit Anthem appeal the first appellate test; the Eleventh Circuit Aetna appeal is also pending.