The Fifth Circuit Decision on No Surprises Act Rulemaking

This case from the Fifth Circuit Court of Appeals addresses legal challenges to the No Surprises Act, a federal law designed to protect patients from unexpected medical bills. The court primarily examines the Qualifying Payment Amount (QPA), which serves as a benchmark for determining how much insurers must pay out-of-network providers. The majority ruling finds that federal agencies acted unlawfully by including "ghost rates"—placeholder fees for services never actually performed—and by excluding bonus and incentive payments from the QPA calculation. However, the court upheld the exclusion of single-case agreements from the data, noting these one-off emergency contracts do not represent typical market rates. Ultimately, the court ordered that the invalid portions of the regulations be vacated and sent back to the agencies for correction. Additional concurring and dissenting opinions debate the procedural methods of notice-and-comment rulemaking and the broader constitutional authority of courts to strike down agency rules.