January 28, 2022

CAP files Amicus Brief in support of AMA, AHA No Surprises Lawsuit

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College of American Pathologists
  • CAP files amicus brief in support of the AMA and AHA’s lawsuit to correct the government’s implementation of the No Surprises Act.

WASHINGTON—The College of American Pathologists (CAP) filed an amicus brief supporting a lawsuit challenging the federal government’s flawed implementation of the No Surprises ActIn the amicus brief, the CAP warned the government’s actions will cause substantial harm and further drive more physicians out of their patients’ health plan networks.

“The College of American Pathologists worked closely with Congress during the development of the No Surprises Act, and we advocated for patient protections, including robust access to health care that’s in their health plan’s network,” said CAP President Emily Volk, MD, FCAP. “Importantly, we continue to believe that the subsequent regulations must support an equitable and balanced system for resolving out-of-network payment disputes. As of today, the rules heavily favor the insurers when their power is already too great. With new rules going into effect on January 1, physicians and hospitals have little choice but to ask the courts to fix regulations that strayed from the law.”

The lawsuit led by the American Medical Association (AMA) and American Hospital Association (AHA) focused on requirements in the federal government’s rules pertaining to the independent dispute resolution process in the No Surprises Act. The law clearly established a fair and impartial independent dispute resolution process where physicians and other providers can settle claims with insurers without patients receiving unexpected large medical bills.

However, the current administration’s rules favor the health insurance industry. The AMA and AHA lawsuit states that the federal government’s regulations deviated from the law but ensured that commercial insurers routinely undercompensate physicians and patients having fewer choices for in-network services.

The lawsuit does not challenge patient protections in the law but seeks alignment between statute and the regulations for the independent dispute resolution process.

The CAP’s amicus brief outlined how the adverse rules will disadvantage pathologists. Specifically, the government added to the No Surprises Act statute a material term that conflicts with Congress’s balanced design for the independent dispute resolution process. By making an insurer-controlled qualifying payment amount as the presumptive benchmark for the independent dispute resolution process, the government warped an independent inquiry into one that is harmful to pathologists and their patients.

The AHA, AMA, and their co-plaintiffs filed their lawsuit against the departments of HHS, Labor, and Treasury, along with the Office of Personnel Management in the U.S. District Court for the District of Columbia. Go to the AMA’s website for copies of the original complaint and a motion to stay.

About the College of American Pathologists 

As the world’s largest organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. As a 501(c)(6) membership organization, the CAP is the only entity representing pathologists with unrestricted advocacy capability and a political action committee, PathPAC. For more information, visit yourpathologist.org to watch pathologists at work and see the stories of the patients who trust them with their care. Read the CAP Annual Report.

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