Alexis Boaz, Associate in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, was quoted in Bloomberg Law Health Law & Business, in “Health Insurers Target Consultant Over Surprise Billing Fraud,” by Lauren Clason. (Read the full version – subscription required.)
Following is an excerpt:
A string of lawsuits against a health-care consultant is spotlighting confusion around the arbitration process meant to stop surprise medical bills, as insurers allege providers are intentionally flooding the zone with ineligible claims. …
The cases underscore the significant role that third-party consultants play in the health-care industry and the increasing scrutiny they’re receiving from clients, lawyers, and lawmakers. The arbitration process under the No Surprises Act boosted opportunities for external vendors as cases surged and as medical providers continue to win the vast majority of disputes against insurers. …
Once cases are in the hands of the arbitrators, both parties have limited means to provide them additional context, said Alexis Boaz, an associate with Epstein Becker & Green PC who helps plans, providers, and arbitrators navigate the process. That makes it hard for them to decide eligibility.
“The IDR entities really have no way to determine that without all the information that they need,” she said.
A rule proposed by the Biden administration two years ago would improve information exchanges between the negotiating parties and the arbitrators, and would require insurers to register eligible plans. The Trump administration tentatively plans to finalize the rule in November.
“It really resolves a lot of the issues with information flow and communication between the parties,” Boaz said. “Because the timelines are really tight, that’s really important.”
