A federal appeals court has ruled that a plastic surgery practice cannot sue Cigna to collect more than $3 million it won through the No Surprises Act’s arbitration process.
The U.S. Court of Appeals for the Second Circuit on Sept. 17 upheld a lower court’s dismissal of the lawsuit brought by East Coast Advanced Plastic Surgery (ECAPS), an out-of-network practice that performs breast reconstruction surgery for cancer patients.
The practice alleged Cigna routinely paid it far less than agreed, so it took the disputes to the independent dispute resolution process and won awards totaling more than $3 million, which are required to be paid within 30 days. Cigna has made no payments, the court said.
Writing for the panel, Circuit Judge Michael Park said the No Surprises Act gives providers a right to be paid but leaves enforcement to the Labor Department, the Treasury Department, HHS and the states. ECAPS argued the Labor Department does little to enforce the awards.
“The relevant question is whether Congress authorizes agency enforcement, not how actively the agency exercises its authority,” Judge Park wrote.
Cigna also has its own ongoing case against the practice. The insurer sued ECAPS in October 2024, claiming its billing practices caused Cigna to overpay by $8.5 million. ECAPS filed its suit in January 2025 in the Southern District of New York, where a judge dismissed it the following month.
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