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Major payer and employer groups are calling on CMS to hit pause on recertifying No Surprises Act arbiters, arguing the current process is riddled with conflicts of interest and bias toward providers. The dispute resolution system has generated over $22 billion in excess spending in its first four years, with providers winning roughly 80% of cases. Groups want stricter standards and more public comment time before any arbiter gets the green light.
Major payer and employer groups are pushing the Trump administration to pause recertifying independent dispute resolution entities (IDREs) under the No Surprises Act — the 2020 law designed to shield patients from unexpected out-of-network bills. The Coalition Against Surprise Medical Billing (CASMB) and the ERISA Industry Committee (ERIC) sent letters to top CMS officials arguing that the current recertification process lacks meaningful scrutiny of whether arbiters are making fair, consistent decisions.
At the heart of the complaint: IDREs are financially incentivized to favor providers. Since arbiters are paid per dispute and receive no reimbursement if a case is deemed ineligible, they're motivated to keep disputes flowing — and rule in providers' favor to encourage continued filings. One recent applicant, Maximus Federal Services, sided with providers in 93.7% of cases where providers sought at least 10 times the in-network rate.
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Why it matters: The No Surprises Act was meant to protect patients, but its arbitration system has grown into a costly, provider-favoring process. Without reform, the dysfunction could continue driving up healthcare costs for insurers, employers, and ultimately, patients.
