In a recent letter, a group of 48 employer and consumer organizations are calling on the Trump Administration to strengthen oversight of certified independent dispute resolution (IDR) entities, which resolve disputes under the No Surprises Act.
The letter was submitted last week to the Departments of Treasury, Health and Human Services and Labor. The signatories include the American Benefits Council, Families USA, the National Alliance of Healthcare Purchaser Coalitions, the Purchaser Business Group on Health and the ERISA Industry Committee.
The No Surprises Act protects patients from unexpected bills and removes them from insurer-provider payment friction. The act requires insurers and providers to enter into 30 days of open negotiation to determine how much providers are paid. If they can’t come to an agreement, either side can use the independent dispute resolution process, in which a provider submits a payment offer and an insurer submits a payment offer and then a neutral arbitrator (called an IDR entity) picks one.
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However, many in the industry are arguing that the IDR process is now being abused by some providers. The process was intended to be a “last-resort backstop” for resolving disputes between health plans and out-of-network providers, initially projected to have 17,000 arbitration cases a year, according to the letter. But in just the first half of 2025, there were over 1.2 million cases.
“This is not organic dispute resolution,” the organizations said. “It is a coordinated, high-volume strategy being systematically exploited by a small number of bad actors at the direct expense of American employers, workers, and families.”
The letter added that providers win about 88% of IDR cases with payments that are 300-900% of the median in-network amount. These costs are then passed on to consumers via higher premiums, deductibles and out-of-pocket expenses.
The organizations also claimed that the IDR system is being “weaponized” by private equity firms. In the first half of 2025, 55% of disputes were initiated by only four companies: Team Health, Radiology Partners, SCP Health and HaloMD. The first three are private equity-backed.
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“These are many of the same firms that spent years deliberately remaining out-of-network to exploit patients and then pivoted to IDR when the No Surprises Act ended direct patient billing,” the letter said. “Now, they are operationalizing arbitration at industrial scale.”
In addition, the groups argued that the IDR process may contain structural conflicts of interest because arbitrators are paid per case decided, creating incentives to prioritize volume over impartiality. The letter also cites concerns that some private equity firms have investments in both healthcare providers filing arbitration claims and the IDR entities deciding those disputes, raising questions about the independence of the arbitration system.
The organizations made several recommendations to the Trump administration to improve the IDR process, including:
- Investigating the independence of certified IDR entities
- Decertifying IDR entities that have conflicts of interest
- Requiring IDR entities to disclose ownership structures, compensation arrangements and outcome data
- Creating an upfront eligibility screening to prevent ineligible claims from going through the IDR portal
“The No Surprises Act promised American patients protection from predatory billing,” the groups said. “That promise is being broken — not by the law, but by those exploiting its implementation for profit. The administration has both the authority and the obligation to act.”
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