# Verdict Consulting Group

> Verdict Consulting Group is a data and analytics consultancy for No Surprises Act and health care litigation: IDR underpayment audits, expert-ready litigation data support, and award and payment tracking for provider groups and their counsel.

Verdict Consulting Group is a data and analytics consultancy, not a law firm, and does not provide legal advice. Content is general information drawn from public sources. Do not send protected health information through this site.

Every insight, answer and case summary on this site cites at least one public source. Dates are ISO 8601.

## Key pages

- [The Docket](https://verdictnsa.com/docket): No Surprises Act litigation tracker
- [Insights](https://verdictnsa.com/insights): sourced analysis of NSA litigation, regulation and IDR operations
- [NSA Answers](https://verdictnsa.com/answers): canonical single-question answers
- [Capabilities](https://verdictnsa.com/capabilities): underpayment audits, litigation data support, award tracking
- [About](https://verdictnsa.com/about): methodology, sourcing and corrections policies
- [Full text for LLMs](https://verdictnsa.com/llms-full.txt)

## Insights

- [Can a provider sue to enforce an unpaid IDR award? Where the courts stand after the Second Circuit](https://verdictnsa.com/insights/can-a-provider-sue-to-enforce-an-unpaid-idr-award): In most courts that have ruled, no. The Fifth Circuit (2025) and Second Circuit (September 17, 2026) hold that the No Surprises Act creates no private right of action to enforce IDR awards, and the Supreme Court declined review of the Fifth Circuit case in January 2026. The Second Circuit left open whether suits to confirm awards are barred. District courts disagree: the District of Maryland found a narrow implied right; courts in Pennsylvania and Illinois found none.
- [How did the TMA lawsuits reshape the federal IDR process, 2022–2026?](https://verdictnsa.com/insights/how-the-tma-lawsuits-reshaped-the-idr-process): Through four suits in the Eastern District of Texas, the Texas Medical Association and co-plaintiffs removed the federal rules that made the qualifying payment amount (QPA) the default answer in IDR. Courts vacated the QPA presumption (2022), the August 2022 weighting rules (affirmed 2024), the 2023 fee increase and batching limits, and, in an August 11, 2026 en banc Fifth Circuit decision, the inclusion of ghost rates and exclusion of incentive payments in QPAs.
- [Payers are suing over IDR awards: what do the 2025–2026 fraud and vacatur suits allege, and how have courts ruled?](https://verdictnsa.com/insights/payer-lawsuits-over-idr-awards-fraud-and-vacatur): Since late 2024, insurers including Aetna, Anthem and Blue Cross Blue Shield plans have sued high-volume IDR filers, alleging false eligibility attestations, RICO violations and fraud, and seeking vacatur of awards and damages. Between April and September 2026, federal district courts dismissed eight: six under the NSA's limit on judicial review and two for lack of federal jurisdiction. The six held that review of IDR determinations is limited to the Federal Arbitration Act's section 10(a) grounds and that fraud known during IDR cannot support vacatur.
- [What changed in the 2026 Federal IDR Operations Rule](https://verdictnsa.com/insights/2026-federal-idr-operations-rule): The Federal Independent Dispute Resolution Operations rule, published at 91 FR 33900 on June 4, 2026 and effective August 3, 2026, revises how No Surprises Act IDR runs. It cuts the administrative fee to $15, caps batches at 50 line items, adds CARC/RARC remittance codes and plan registration, and rewrites open negotiation. Provisions apply on staggered dates. A correction followed August 28, 2026.

## NSA Answers

- [Can a health plan challenge an IDR award in court?](https://verdictnsa.com/answers/can-a-health-plan-challenge-an-idr-award-in-court): 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.
- [Can a health plan vacate an IDR award for fraud?](https://verdictnsa.com/answers/can-a-health-plan-vacate-an-idr-award-for-fraud): 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.
- [Can a provider sue for an unpaid IDR award in the Fifth Circuit?](https://verdictnsa.com/answers/can-a-provider-sue-for-an-unpaid-idr-award-in-the-fifth-circuit): No, not under the No Surprises Act itself. In Guardian Flight v. Health Care Service Corp. (June 12, 2025), the Fifth Circuit held the Act contains no private right of action to enforce an IDR award, and the Supreme Court denied certiorari on January 12, 2026. The court also rejected the providers' derivative ERISA and Texas quantum meruit claims.
- [Can a provider sue to enforce an IDR award?](https://verdictnsa.com/answers/can-a-provider-sue-to-enforce-an-idr-award): It depends on the court, but both appellate courts to rule say no. The Fifth Circuit (June 2025) and Second Circuit (September 17, 2026) hold the No Surprises Act creates no private right of action to enforce IDR awards. The Second Circuit left open whether suits to confirm awards are barred. The District of Maryland found a narrow implied right.
- [Can federal IDR disputes be batched?](https://verdictnsa.com/answers/can-idr-disputes-be-batched): Yes. Multiple qualified IDR items and services can be decided in one batched determination. Under the 2026 Federal IDR Operations rule, for disputes whose open negotiation period begins on or after November 1, 2026, a batch may hold up to 50 line items and must fit one of three categories the rule defines.
- [Do state surprise-billing laws override the federal IDR process?](https://verdictnsa.com/answers/do-state-surprise-billing-laws-override-federal-idr): Where they apply, yes. The No Surprises Act defers to a specified state law that sets the out-of-network payment amount for a plan the state can regulate, and to All-Payer Model Agreements. In those cases the state method, not federal IDR, sets payment. A state law reaches a plan only to the extent ERISA preemption allows.
- [How long does a health plan have to pay an IDR award?](https://verdictnsa.com/answers/how-long-does-a-health-plan-have-to-pay-an-idr-award): Thirty calendar days. Federal regulations require the plan or issuer to pay the selected offer, less the initial payment and any patient cost sharing, directly to the provider within 30 calendar days after the certified IDR entity's determination. If the selected offer is below what was already paid, the provider owes the plan the difference on the same timeline.
- [How many IDR disputes have been filed?](https://verdictnsa.com/answers/how-many-idr-disputes-have-been-filed): More than 5.1 million disputes had been submitted to the federal IDR process as of January 31, 2026, the Departments reported in the Federal IDR Operations rule, citing CMS data. CMS reports 1,372,563 disputes initiated from July 1 to December 31, 2025 alone. Certified IDR entities found 355,804 disputes ineligible from April 2022 through December 2024.
- [How often do providers win federal IDR disputes?](https://verdictnsa.com/answers/how-often-do-providers-win-federal-idr): Providers win most federal IDR payment determinations. CMS reports that providers, facilities and air ambulance providers prevailed in about 85% of determinations from July 1 to December 31, 2025, and about 88% from January 1 to June 30, 2025. In the second half of 2025, the prevailing offer exceeded the QPA in about 87% of determinations.
- [What are the federal IDR administrative and certified IDR entity fees in 2026?](https://verdictnsa.com/answers/what-are-the-federal-idr-fees-in-2026): For disputes initiated on or after June 11, 2026, the federal administrative fee is $15 per party per dispute, down from $115, and it is non-refundable. Certified IDR entity fees range from $200 to $840 for single determinations and $268 to $1,173 for batched determinations. The party whose offer is not selected pays the entity fee.
- [What did the Second Circuit decide in East Coast Advanced Plastic Surgery v. Cigna?](https://verdictnsa.com/answers/what-did-the-second-circuit-decide-in-east-coast-advanced-plastic-surgery-v-cigna): On September 17, 2026, the Second Circuit held that the No Surprises Act does not provide a private right of action to enforce IDR payment awards, and affirmed dismissal of a provider's suit over more than $3 million in awards against Cigna. It joined the Fifth Circuit, noting the Act cross-references FAA vacatur but not confirmation.
- [What did the Texas Medical Association v. HHS cases decide?](https://verdictnsa.com/answers/what-did-the-tma-v-hhs-cases-decide): 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.
- [What does an IDR underpayment audit check?](https://verdictnsa.com/answers/what-does-an-idr-underpayment-audit-check): An IDR underpayment audit compares each award with what federal rules require the plan to pay: the selected offer, less the initial payment and patient cost sharing, paid within 30 calendar days of the determination. It can also test whether the initial payment or denial arrived within 30 calendar days of the bill and carried the required QPA disclosures.
- [What does Verdict Consulting Group do?](https://verdictnsa.com/answers/what-does-verdict-consulting-do): Verdict Consulting Group is a data and analytics consultancy for No Surprises Act and health care litigation. We audit IDR underpayments, build expert-ready analyses and damages models for counsel, run eligibility forensics, and track award payment claim by claim for provider groups. We are not a law firm and do not provide legal advice.
- [What happens if a health plan does not pay an IDR award?](https://verdictnsa.com/answers/what-happens-if-a-health-plan-does-not-pay-an-idr-award): The statute relies mainly on federal enforcement. Unpaid awards can be reported to the No Surprises Help Desk, and under 42 U.S.C. 300gg-22 HHS may impose civil money penalties of up to $100 per day for each affected individual. Whether a provider can also sue to collect depends on the court: the Fifth and Second Circuits say no.
- [What is the CARC/RARC requirement in the 2026 Federal IDR Operations rule?](https://verdictnsa.com/answers/what-is-the-carc-rarc-requirement-in-the-2026-idr-rule): The 2026 Federal IDR Operations rule requires plans and issuers to use specified claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) on remittance advice to out-of-network providers, showing whether a claim is subject to surprise-billing protections and federal IDR. Under July 17, 2026 guidance, it applies to services furnished from January 1, 2027.
- [What is the cooling-off period after an IDR determination?](https://verdictnsa.com/answers/what-is-the-idr-cooling-off-period): The cooling-off period is the 90 calendar days after an IDR payment determination during which the initiating party cannot file a new dispute against the same party over the same or a similar item or service. Claims whose open negotiation ends in that window can be submitted within 30 business days after it closes.
- [What is the federal IDR Gateway?](https://verdictnsa.com/answers/what-is-the-federal-idr-gateway): The IDR Gateway is the Departments' new secure, centralized platform for the federal IDR process, replacing single-use web forms in late 2026. Users can start and respond to disputes, track dispute status and view organization dashboards. CMS says the web forms will no longer be available outside the Gateway after January 15, 2027, with one exception.
- [What is the Federal IDR Operations Rule?](https://verdictnsa.com/answers/what-is-the-federal-idr-operations-rule): The Federal Independent Dispute Resolution Operations rule is a final rule published at 91 FR 33900 on June 4, 2026, effective August 3, 2026, and corrected at 91 FR 55462 on August 28, 2026. It revises how No Surprises Act IDR runs, covering CARC/RARC codes, open negotiation, batching, a $15 administrative fee and plan registration.
- [What is the open negotiation period in the No Surprises Act?](https://verdictnsa.com/answers/what-is-the-open-negotiation-period): The open negotiation period is a required 30-business-day window in which an out-of-network provider and a health plan try to agree on a payment amount before federal IDR. Either party may start it within 30 business days of the initial payment or denial. If no agreement is reached, IDR must be initiated within the following 4 business days.
- [What is the qualifying payment amount (QPA)?](https://verdictnsa.com/answers/what-is-the-qualifying-payment-amount): The qualifying payment amount (QPA) is a plan's median contracted rate for the same or a similar service, by provider specialty and geographic region, as of January 31, 2019, adjusted each year for inflation. Certified IDR entities must consider it in every payment determination. In August 2026 the en banc Fifth Circuit held that non-negotiated ghost rates cannot be counted.
- [What makes a dispute ineligible for federal IDR?](https://verdictnsa.com/answers/what-makes-a-dispute-ineligible-for-federal-idr): A dispute is ineligible if it does not involve a qualified IDR item or service, for example because a specified state law, an All-Payer Model Agreement, Medicare or Medicaid governs payment, or if open negotiation, timing, batching or cooling-off rules were not met. Certified IDR entities found 355,804 disputes ineligible from April 15, 2022 to December 31, 2024.

## The Docket

- [Anthem Blue Cross Life and Health Insurance Co. v. HaloMD, LLC](https://verdictnsa.com/docket/anthem-blue-cross-v-halomd) (C.D. Cal. → 9th Cir.): Anthem sued HaloMD and affiliated billing companies and providers, alleging RICO and state-law violations and seeking vacatur of IDR awards. On April 9, 2026, the Central District of California dismissed without leave to amend: no FAA vacatur ground was pleaded, the NSA bars other federal review of IDR determinations, and state claims were left to state court. Ninth Circuit briefing is under way.
- [Texas Medical Association v. U.S. Department of Health and Human Services (TMA III)](https://verdictnsa.com/docket/tma-v-hhs-tma-iii) (E.D. Tex. → 5th Cir. (en banc)): Providers challenged the rules for calculating the qualifying payment amount (QPA). The district court vacated them in August 2023; a Fifth Circuit panel reversed in 2024, and the full court reheard the case. On August 11, 2026, the en banc court affirmed vacatur of the ghost-rate and incentive-payment rules, reversed on the single-case-agreement exclusion, and remanded. The mandate issued October 2, 2026.
- [United Healthcare Services, Inc. v. Radiology Partners, Inc.](https://verdictnsa.com/docket/unitedhealthcare-v-radiology-partners) (D. Ariz.): UnitedHealthcare alleged that Radiology Partners knowingly submitted ineligible claims to the federal IDR process to obtain excessive awards. After the court granted the defendants' motion to strike on September 16, 2026, the parties filed a joint notice of settlement on October 1, 2026. The court ordered the case dismissed with prejudice within 45 days unless a stipulation is filed first.
- [Anthem Health Plans of Virginia, Inc. v. AGS Health, Inc.](https://verdictnsa.com/docket/anthem-virginia-v-ags-health) (W.D. Va.): Anthem's Virginia plans sued a billing company and affiliated emergency physician groups over their use of the federal IDR process. On September 30, 2026, the Western District of Virginia dismissed the complaint with prejudice, holding that the plans did not plausibly allege fraud or excess-of-powers grounds for vacatur under FAA § 10(a)(1) or (a)(4), and that IDR entities act within their powers when deciding eligibility.
- [Blue Cross Blue Shield of Texas v. HaloMD, LLC](https://verdictnsa.com/docket/bcbs-texas-v-halomd) (E.D. Tex. → 5th Cir.): BCBS of Texas alleged that IDR vendor HaloMD submitted ineligible claims to the federal IDR process and sought damages for the resulting awards. On May 22, 2026, the Eastern District of Texas granted HaloMD's motion to dismiss, finding the NSA bars review of IDR eligibility determinations and the claims were an impermissible collateral attack on the awards. BCBSTX appealed to the Fifth Circuit the same day.
- [East Coast Advanced Plastic Surgery, LLC v. Cigna Health and Life Insurance Co.](https://verdictnsa.com/docket/east-coast-advanced-plastic-surgery-v-cigna) (S.D.N.Y. → 2d Cir.): A plastic surgery practice sued Cigna over more than $3 million in unpaid IDR awards. The Southern District of New York dismissed its claims in August 2025. After argument on June 17, 2026, the Second Circuit affirmed on September 17, 2026, holding that the No Surprises Act creates no private right of action to enforce IDR payment awards.
- [Aetna Health Inc. v. Radiology Partners, Inc.](https://verdictnsa.com/docket/aetna-health-v-radiology-partners) (M.D. Fla. → 11th Cir.): Aetna alleged that Radiology Partners routed claims through an out-of-network Florida practice to win inflated IDR awards. On April 16, 2026, the Middle District of Florida dismissed the amended complaint with prejudice: the alleged fraud was discoverable before or during IDR, and the remaining claims were preempted. Aetna appealed to the Eleventh Circuit, where briefing is under way.
- [Rowe Plastic Surgery of NJ, LLC v. Aetna Life Insurance Co.](https://verdictnsa.com/docket/rowe-plastic-surgery-v-aetna) (D.N.J.): Rowe was designated the lead case for hundreds of New Jersey suits seeking to enforce IDR awards, with the others stayed in January 2026 pending Aetna's motion to dismiss. The plaintiff voluntarily dismissed on May 7, 2026; the court then designated East Coast Plastic Surgery v. Aetna (No. 25-15052) as the substitute lead case and so-ordered the dismissal on September 4, 2026.
- [PHI Health, LLC v. Health Care Service Corp.](https://verdictnsa.com/docket/phi-health-v-hcsc-nd-ill) (N.D. Ill. → 7th Cir.): An air ambulance provider sued HCSC over overdue IDR payment awards under the NSA, the FAA, ERISA and Illinois law. On August 5, 2026, Judge Kennelly dismissed, holding the NSA creates no implied private right of action and the FAA cannot be used to confirm IDR awards. Judgment entered August 18; PHI appealed on August 19, and the Seventh Circuit consolidated it with four related SpecialtyCare and PHI appeals against HCSC.
- [Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. v. HaloMD, Inc.](https://verdictnsa.com/docket/bcbs-georgia-v-halomd) (N.D. Ga. → 11th Cir.): The Georgia Blue plan sued HaloMD and two provider groups, alleging misrepresentations in the IDR process. On July 10, 2026, the Northern District of Georgia dismissed the amended complaint with prejudice, holding the plan pleaded itself out of court on fraud-based vacatur because it could have objected before the IDR entity. The plan appealed to the Eleventh Circuit on August 6, 2026.
- [UnitedHealthcare Insurance Co. v. Maui Memorial Emergency Medical Associates, Inc.](https://verdictnsa.com/docket/unitedhealthcare-v-maui-memorial) (D. Haw.): UnitedHealthcare brought a fraud claim against an emergency physician group over its use of the federal IDR process. On July 7, 2026, the District of Hawaii dismissed the case without prejudice and without leave to amend for lack of subject-matter jurisdiction, finding no substantial federal issue in the state-law fraud claim and noting the insurer bypassed the NSA's FAA-based review.
- [Guardian Flight LLC v. Aetna Life Insurance Co.](https://verdictnsa.com/docket/guardian-flight-v-aetna-d-conn) (D. Conn.): Six air ambulance companies sued Aetna and Cigna over hundreds of unpaid or late IDR awards. On May 14, 2025, Judge Shea held that the No Surprises Act implies a private right of action to enforce IDR awards and let assigned ERISA § 502(a)(1)(B) benefit claims and a CUTPA claim proceed. On June 16, 2026, he dismissed Aetna's counterclaims alleging the providers manipulated IDR. The case is pending.
- [Agag v. Cigna Health and Life Insurance Co.](https://verdictnsa.com/docket/agag-v-cigna) (D. Conn. → 2d Cir.): A plastic surgeon sought confirmation of unpaid IDR awards against Cigna. On April 15, 2026, Judge Underhill dismissed the NSA damages and FAA § 9 claims but, without finding an implied right of action, held that confirmation is not 'judicial review' barred by the NSA and confirmed the awards; judgment for $142,567.99 entered April 16. Cigna appealed to the Second Circuit (No. 26-1241).
- [UnitedHealthcare of Pennsylvania, Inc. v. NorthStar Anesthesia of Pennsylvania, LLC](https://verdictnsa.com/docket/unitedhealthcare-pennsylvania-v-northstar-anesthesia) (E.D. Pa.): UnitedHealthcare sought declarations and an injunction after an anesthesia provider took a Medicaid patient's claim, ineligible for federal IDR, through the process. On April 28, 2026, Judge Kearney dismissed the common-law fraud claim without prejudice for lack of subject-matter jurisdiction, noting the insurer had not sought vacatur under the NSA's FAA-based review.
- [Advanced Vascular Associates v. Horizon Blue Cross Blue Shield of New Jersey](https://verdictnsa.com/docket/advanced-vascular-assocs-v-horizon-bcbsnj) (E.D. Pa.): A provider asked the Eastern District of Pennsylvania to confirm an unpaid IDR award or let it sue under the No Surprises Act. On April 7, 2026, Judge Wolson granted Horizon judgment on the pleadings and closed the case: Congress authorized neither FAA confirmation of IDR awards nor a private cause of action to compel payment.
- [PHI Health, LLC v. Optimum Choice, Inc.](https://verdictnsa.com/docket/phi-health-d-md) (D. Md.): An air ambulance provider sued Optimum Choice, a UnitedHealthcare affiliate, to enforce an unpaid IDR award. On March 27, 2026, Judge Abelson denied the motion to dismiss, holding that the No Surprises Act itself authorizes judicial enforcement of an IDR payment obligation. The case remains pending in the District of Maryland.
- [Guardian Flight, L.L.C. v. Health Care Service Corp.](https://verdictnsa.com/docket/guardian-flight-v-health-care-service-corp) (N.D. Tex. → 5th Cir. → SCOTUS): Two air ambulance providers sued HCSC for failing to pay IDR awards on time. The Northern District of Texas dismissed, and on June 12, 2025 the Fifth Circuit affirmed, holding the No Surprises Act has no private right of action and the ERISA and quantum meruit claims were inadequately pleaded. Rehearing en banc was denied, and the Supreme Court denied certiorari on January 12, 2026.
- [REACH Air Medical Services LLC v. Kaiser Foundation Health Plan Inc.](https://verdictnsa.com/docket/reach-air-medical-v-kaiser) (M.D. Fla. → 11th Cir.): An air ambulance provider asked a federal court to vacate an IDR award, alleging Kaiser misstated its qualifying payment amount to the IDR entity. The Middle District of Florida dismissed the suit, and on November 19, 2025 the Eleventh Circuit affirmed in a published opinion, holding that NSA awards receive the FAA's narrow review and the complaint did not plead fraud, undue means or excess of authority.
- [Texas Medical Association v. U.S. Department of Health and Human Services (TMA II)](https://verdictnsa.com/docket/tma-v-hhs-tma-ii) (E.D. Tex. → 5th Cir.): Providers challenged the August 2022 final rule that again directed IDR entities to give the QPA special weight. The Eastern District of Texas vacated the challenged provisions on February 6, 2023, and the Fifth Circuit affirmed on August 2, 2024, agreeing that the rule placed a thumb on the scale for the QPA contrary to the statute.
- [Texas Medical Association v. U.S. Department of Health and Human Services (TMA IV)](https://verdictnsa.com/docket/tma-v-hhs-tma-iv) (E.D. Tex.): Providers challenged the Departments' December 2022 guidance raising the IDR administrative fee to $350 and the September 2021 interim final rule's batching restrictions. On August 3, 2023, the Eastern District of Texas vacated the $350 fee and the batching provisions for bypassing notice and comment, but denied fee refunds and a deadline extension.
- [Texas Medical Association v. U.S. Department of Health and Human Services (TMA I)](https://verdictnsa.com/docket/tma-v-hhs-tma-i) (E.D. Tex.): TMA challenged the September 2021 interim final rule that told IDR entities to presume the qualifying payment amount (QPA) was the appropriate payment. On February 23, 2022, the Eastern District of Texas vacated those provisions as contrary to the Act and issued without notice and comment. The government's Fifth Circuit appeal was voluntarily dismissed on October 24, 2022.
- [LifeNet, Inc. v. U.S. Department of Health and Human Services (LifeNet I)](https://verdictnsa.com/docket/lifenet-v-hhs) (E.D. Tex.): An air ambulance provider challenged the air ambulance IDR provisions of the September 2021 interim final rule. On July 26, 2022, the Eastern District of Texas entered judgment for LifeNet and vacated the final sentence of the provisions directing how IDR entities weigh the QPA in air ambulance disputes. LifeNet's later challenges were consolidated into TMA II and TMA III.