No Surprises Act · IDR · Health care litigation
Litigation-grade data for the No Surprises Act.
IDR, underpayment and award-enforcement analytics for provider groups and their counsel — built from determinations, remittances and the public record, and prepared to hold up in a dispute.
Capabilities
Three ways we support a dispute.
- 01
Underpayment audit
Claim-level reconciliation of IDR outcomes against what payers actually paid — identifying unpaid, late and short-paid determinations across a portfolio.
- 02
Litigation data support
Expert-ready analyses for counsel in NSA and health care disputes: damages models, eligibility forensics and the data work behind declarations and reports.
- 03
Award & payment tracking
Ongoing monitoring of IDR awards from determination to payment, so provider groups and their counsel see enforcement exposure as it develops.
The Docket
Latest on the Docket
4 cases shown
- Anthem Blue Cross Life and Health Insurance Co. v. HaloMD, LLC
C.D. Cal. → 9th Cir.Payer v. provider
Status: On appeal
Last ruling: — Appellees' response briefs filed; appeal pending.
- Texas Medical Association v. U.S. Department of Health and Human Services (TMA III)
E.D. Tex. → 5th Cir. (en banc)Challenge to rules
Status: Proceeding
Last ruling: — Mandate issued.
- United Healthcare Services, Inc. v. Radiology Partners, Inc.
D. Ariz.Payer v. provider
Status: Settled
Last ruling: — Court advised of settlement; case to be dismissed with prejudice within 45 days absent a stipulation, pending motions denied as moot.
- Anthem Health Plans of Virginia, Inc. v. AGS Health, Inc.
W.D. Va.Payer v. provider
Status: Dismissed
Last ruling: — Motions to dismiss granted; no plausible FAA § 10(a)(1) or (a)(4) vacatur ground; IDR entities do not exceed their powers by deciding eligibility; complaint dismissed with prejudice.
| Case | Court | Issue | Status | Last ruling |
|---|---|---|---|---|
| Anthem Blue Cross Life and Health Insurance Co. v. HaloMD, LLCFiled Jul 7, 2025 | C.D. Cal. → 9th Cir. | Payer v. provider | On appeal | — Appellees' response briefs filed; appeal pending. |
| Texas Medical Association v. U.S. Department of Health and Human Services (TMA III)Filed Nov 30, 2022 | E.D. Tex. → 5th Cir. (en banc) | Challenge to rules | Proceeding | — Mandate issued. |
| United Healthcare Services, Inc. v. Radiology Partners, Inc.Filed Aug 8, 2025 | D. Ariz. | Payer v. provider | Settled | — Court advised of settlement; case to be dismissed with prejudice within 45 days absent a stipulation, pending motions denied as moot. |
| Anthem Health Plans of Virginia, Inc. v. AGS Health, Inc.Filed Nov 5, 2025 | W.D. Va. | Payer v. provider | Dismissed | — Motions to dismiss granted; no plausible FAA § 10(a)(1) or (a)(4) vacatur ground; IDR entities do not exceed their powers by deciding eligibility; complaint dismissed with prejudice. |
NSA Answers
Direct, sourced answers to the questions provider groups and counsel ask most. Each links to a canonical page with full citations.
All answersQuestions we answer
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 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.
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.
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.
What does Verdict Consulting Group 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.
Newsletter
The NSA Brief — twice a week
New rulings, rule changes and IDR operations data, summarized with sources. Email only — no spam, no patient data.