05.29.2026 / Statement

While Increasing Transparency, New Surprise Billing Regulation Won’t Stop Provider Abuses and Inflated Prices

WASHINGTON, D.C. – In response to the release of the finalized Independent Dispute Resolution (IDR) Operations rule by the Centers for Medicare and Medicaid Services (CMS), executive director of Families USA Anthony Wright issued the following statement:

“The No Surprises Act has delivered real protections for patients — shielding them from devastating out-of-network bills that could send people to bankruptcy. While protecting patients in many cases, some providers have found ways to game the system, undermining the goal of containing rising health care costs.

“Consumer advocates appreciate that this final regulation includes important steps to increase transparency, require more standardization, and reduce ineligible disputes, even if more reform is needed.

“While we acknowledge the positive incremental steps, this new regulation will not stop the biggest abusers from continuing to manipulate the independent dispute resolution process, generating millions in profits from inflated payment determinations at consumers’ expense. More needs to be done to rein in private equity and its ability to game the IDR process. The CBO initially estimated there would be 17,000 annual IDR cases, but instead, we’ve seen more than 5 million disputes since the program launched in April of 2022. That overwhelming surge is being driven by certain providers, and particularly those backed by private equity, who have found ways to game the system and secure payment several times higher than what they would have received by negotiating with insurers directly. This final rule fails to stop these abuses, which threaten to further increase health insurance premiums.

“In fact, one provision may make things worse — reducing the IDR administrative fee from $115 to $15 is likely to make it even easier for these corporate-backed providers to flood the dispute resolution process and increase the number of disputes by as much as 30%.

“Families USA was a proud supporter of the No Surprises Act and its patient protections, but we were aware and warned about these gaps and loopholes that are now being exploited. To resolve surprise medical bill payment issues, we advocated for setting benchmark rates based on median in-network prices, rather than this baseball-style arbitration system without clear guidelines, which invites manipulation. To truly protect consumers and keep costs down, Congress must close loopholes that allow providers to profit at patients’ expense.”