Health Brief from The Washington Post

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By Megan R. Wilson

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In today’s issue:

A federal judge sides with HaloMD in surprise billing suit, but insurers are pressing on with lawsuits in other states
The ruling could put more pressure on policymakers to step in and revise the No Surprises Act, the law enacted in 2020 meant to protect consumers
In a flurry of White House meetings, providers are seeking to shape a pending rule implementing parts of the law

Good afternoon, and thanks for checking in with Health Brief. Somebody get Elizabeth Banks on the phone, as there are cocaine sharks in the Bahamas and I’ve already started writing the screenplay.

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The battle over surprise bills is only beginning. (iStock)


	The Lead Brief

A California federal court handed insurers a setback in their strategy to take on what they call abuses of the law meant to protect patients from surprise medical bills, throwing out one of several lawsuits against a company called HaloMD. But that doesn’t mean the battle is over.

HaloMD, a middleman that handles arbitration for providers, hailed the dismissal as a “landmark victory.”

The company has become one of the most prolific and controversial players in the law’s independent dispute resolution process.

But, before we talk about that, let’s discuss how we got here.

Signed into law by President Donald Trump in December 2020, the No Surprises Act stemmed from an influx of patients being hit with massive medical bills after being unknowingly treated by providers outside of their insurance network.

Since then, providers and insurers have been fighting over aspects of the law and its implementation — and pointing fingers at the other for allegedly flouting it, both in court and with their own shoe-leather lobbying efforts.

The law targeting surprise bills bans judicial review of disputed medical claims except in certain circumstances.

What’s new: In a 22-page decision Judge Karen E. Scott wrote that the insurer didn’t meet those standards to sue and, instead, the insurer had the opportunity to challenge the eligibility of the disputed bills via arbitrators.

Anthem Blue Cross tried to argue that HaloMD games the surprise-billing arbitration system by filing a flood of ineligible claims and racking up unfounded arbitration wins so egregious they amounted to fraud.

But the court wasn’t persuaded.

Scott told Anthem Blue Cross that its “policy-based arguments would be better directed at Congress, which alone has the power to rewrite” the No Surprises Act.

While insurers have claimed that mediators are incentivized to disregard their objections — because they’re only paid if medical claims are deemed eligible for review — Scott also said that “such financial incentives are not akin to bad faith or bribery.”

HaloMD filed hundreds of thousands of disputes with mediators last year and boasts an 88 percent win rate.

“Anthem’s brazen attempt to weaponize the federal courts and undo an arbitration process it simply doesn’t like has been rejected in the clearest possible terms,” said Patrick Velliky, HaloMD’s chief external affairs officer. “Their strategy backfired completely.”

But the ruling isn’t an end to the war between insurers and providers about how the No Surprises Act’s arbitration process should work.

Janey Kiryluik, a spokesperson for Anthem’s parent company Elevance Health, tells me the company plans to appeal. Kiryluik said the decision was made based on “a procedural issue and did not address most of our arguments.”


	Litigation Report

The federal ruling in California is only the first move in a growing docket of insurer cases alleging that a small number of providers and middlemen such as HaloMD are exploiting the system. There are also cases against HaloMD working their way through courts in Georgia, Ohio and Texas.

UnitedHealth Group, the nation’s largest insurance company, has also filed lawsuits against several providers alleging they are abusing the surprise billing law’s arbitration process to improperly secure higher payments.

At least three of those cases — in Arizona, Hawaii and Pennsylvania — target providers that have used HaloMD.

In the Pennsylvania lawsuit against NorthStar Anesthesia, UnitedHealthcare said that “weaponizing” the No Surprises Act is part of its “business strategy.”

The providers in each of these cases have denied all wrongdoing.

In moving to dismiss the case, NorthStar argues that UnitedHealthcare is trying to use the legal system to replace the existing mediation process “with a draconian strict liability regime for ineligible disputes that neither Congress nor [the Centers for Medicare and Medicaid Services] contemplated.”

Each of those district courts is located in a different appellate circuit, potentially setting up a path for the issue to head to the Supreme Court if there are disagreements among federal judges around the country.

It’s also worth noting, as Katie Keith of Georgetown Law’s Center for Health Policy and the Law points out, that the Supreme Court has so far shown little appetite for weighing in on disputes over the surprise billing law’s arbitration system.

Just last year, the high court declined to take up a case brought by an air ambulance company that accused an insurer of violating the No Surprises Act by failing to pay claims on time.


	Executive Health Brief

The ruling from the California federal judge comes as HaloMD is ramping up its Washington lobbying efforts alongside the rising number of providers’ billing disputes they handle.

The sharp increase in disputed medical bills could put more pressure on the Trump administration — and lawmakers — to revisit the law and how it works in practice.

When regulators began implementing the law in 2021, they estimated that just 17,000 medical claims would be submitted for arbitration each year. Meanwhile, there were 1.2 million disputed claims in the first half of 2025 alone, according to Centers for Medicare and Medicaid Services data.

HaloMD represented 1 percent of all disputed medical claims in 2023 and 6 percent in 2024, according to an analysis by the Center on Health Insurance Reforms at Georgetown University.

In 2025, HaloMD submitted 17 percent of all the disputed claims in the first quarter and 22 percent of all disputes in the second quarter, according to an updated analysis published in Health Affairs last month.

→ Some insurance lobbyists tell me they’ve already been intensifying their own efforts to lobby Congress and regulators to provide more federal oversight to the process, among other changes, but providers appear to be most publicly active on pending surprise billing rules.

What to watch: There’s a rule dating back to the Biden administration meant to tweak the law’s independent dispute resolution process that’s now under review at the White House.

Since that review started in January, more than a dozen companies and other groups — most of them representing providers — have rushed to meet with officials, according to federal records.

HaloMD, which met regulators and White House staff on Feb. 9, said it supported much of the proposed rulemaking.

Meanwhile, Congress is not likely to be eager to revisit the issue and make the amendments being requested from either side.

While the law has prompted myriad disputes between insurance companies and health care providers, the aim of the No Surprises Act for consumers — keeping patients from being hit with massive bills after unknowingly seeing an out-of-network provider — has been a resounding success.


	Jobs Report

Ascension, one of the largest Catholic health systems in the country, has named Samuel Marchio as a senior vice president and chief government relations and policy officer. Marchio comes from Elevance Health, where he worked for 15 years.

Gavin Proffitt has joined AbbVie as the drugmaker’s director of federal government affairs. He comes from the office of Sen. Ron Johnson (R-Wisconsin), but has also worked for Republicans on the House Energy and Commerce Committee, the Centers for Medicare and Medicaid Services, and the Republican Study Committee.