STAT+: HaloMD faces lawsuit alleging No Surprises Act middleman used ‘sham letter,’ misleading data
Article excerpt
Highmark Health has sued HaloMD, a company that mediates payment disputes between insurers and doctors under the No Surprises Act, becoming the fourth major insurer to challenge the firm in court. Highmark alleges that HaloMD used a "sham letter" and misleading data to win arbitration cases favoring doctors and hospitals. The lawsuit seeks to overturn previous arbitration wins and highlights growing tension over how the 2021 law, designed to protect patients from surprise medical bills, is being enforced. Multiple insurers now question whether HaloMD's arbitration process is fair or tilted toward healthcare providers.
A fourth major health insurer is suing HaloMD over its use of the No Surprises Act’s arbitration process, arguing that the middleman deceived arbitrators by sending them a “sham letter” and misleading price data.
Highmark Health, a Pennsylvania-based Blue Cross Blue Shield licensee with over 7 million members, claims in a complaint filed June 1 in U.S. District Court for the Western District of Pennsylvania that HaloMD and one of its clients, a neuromonitoring provider called Bromedicon, submitted more than 450 ineligible disputes with the company and won more than $3.9 million. Like the three Blue Cross plans before it, Highmark wants those awards tossed and its money returned.
“Defendants’ scheme is not a good faith attempt to obtain fair reimbursement,” Highmark’s complaint says. “It is a deliberate effort to wrongfully extract inflated payments from Highmark.”
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