Biden administration rolls out NSA fees

Providers and insurers that use the No Surprises Act's arbitration process will have to pony up $115 per dispute, per a final rule rolled out Monday. That's less than half of what they would have paid under the Biden administration's proposed fee increase earlier this year, STAT's Tara Bannow writes.

The biggest thorn in the NSA's side — and the most litigated — has been its method for determining the appropriate out-of-network payment amounts. But fees might be a close second. Providers and insurers alike have complained that the fees add up when they have multiple disputes open. In August, a judge threw out Medicare's plan to bump the fee from $50 to $350.

The federal departments that administer the NSA dispute process arrived at $115 by dividing their estimated expenses by the estimated total number of fees paid in the year. Originally, they had proposed dividing by the number of disputes closed, but progress has been dismal on that front. A separate rule that's currently open for comment would update the fee to $150 per dispute in 2025.

And at this point, years into the surprise billing debate, Blackstone-backed physician staffing firm TeamHealth hired its first in-house lobbyist, Lance Leggitt. He's an alumnus of the Trump and George W. Bush White Houses, and served as HHS chief of staff during the Trump administration. TeamHealth is in difficult financial straits lately.

medicare

Another battlefront for drug price negotiation

The Justice Department filed its latest argument against the slew of lawsuits seeking to dismantle the Medicare drug negotiation program, and it's adding a new line of attack. The DOJ's Friday filing — this time in a Chamber of Commerce suit — for the first time targets industry's complaints over an up to 95% excise tax on sales for companies that refuse to allow their drugs in the program.

The Biden administration is arguing that the court should dismiss this challenge because it preemptively targets a tax that hasn't gone into effect and also doesn't name the agency that would implement the tax.

Besides those fundamental issues, the Chamber's logic is also flawed, DOJ argues. "Even if the excise tax were deemed a fine, it would not be a grossly disproportionate one, as the excise tax is proportional to the harm to the public…and within the range of other constitutionally permissible exactions." Read more from Rachel on the various legal battles around negotiation.

pricing policy

Get to know the new health care pricing guards

Three major government agencies are adding new officials to investigate price-gouging in health care. President Biden has tasked the new counselors across FTC, HHS and DOJ with taking on "corporate greed" in the industry. But what will that actually look like?

The officials are supposed to investigate private equity's impact in the health sector, and dig into anti-competitive practices, such as firms "rolling up" small practices in transactions that don't meet antitrust thresholds. They're also aiming to train employees and share data, STAT's Britany Trang reports.

HHS isn't typically involved in antitrust investigations, but this initiative could change that, antitrust experts told her. Read about how. Also, shameless applause for my colleagues: The release also cited STAT's reporting on private equity buying lucrative businesses in controversial autism therapy and travel nursing industries.

health insurance

Biden admin asks judge to toss Humana suit

Justice Department officials are asking a federal judge to dismiss a Humana lawsuit alleging that the government's new audits of Medicare Advantage plans are unlawful. If that doesn't happen, the DOJ said in a new filing that the case should be moved out of a Texas district with a judge who has a track record of striking down federal health care laws, Bob Herman writes.

Federal lawyers argue Humana doesn't have a case against the audits because they haven't actually happened yet, and won't for a while. HHS finalized a rule earlier this year that would put Medicare Advantage plans under a more rigorous microscope but so far, there are very few details on how it would work.

Humana, the second-largest Medicare Advantage insurer in the country, sued the government in September over the plan. Bob explains the specifics.

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