Highmark has filed a lawsuit against medical billing company HaloMD and neuromonitoring provider Bromedicon, alleging they exploited the No Surprises Act’s independent dispute resolution process through hundreds of ineligible filings and fabricated negotiation documents.
The complaint, filed June 1 in the Western District of Pennsylvania, accuses the two companies of knowingly violating the NSA’s 90-day cooling-off period, which bans providers from initiating new IDR disputes involving the same procedure code and payer within 90 days of a previous decision. According to the complaint, HaloMD filed new disputes for identical procedure codes within days of receiving determinations, sometimes the same day, despite notices in each determination identifying the date new disputes could be filed.
Beyond the cooling-off violations, Highmark alleges the companies submitted fabricated evidence to arbitrators in the form of a template letter that Highmark says it never received and that contained generic placeholder names. The letter was styled as a “Request for In-Network Contract Rates” and reportedly sent by Bromedicon to demonstrate good-faith negotiation efforts, per the complaint.
In recent weeks, federal judges in California and Texas dismissed lawsuits brought by Elevance Health and BCBS Texas against HaloMD, and a Florida court dismissed an Aetna suit against Radiology Partners, with each ruling finding that federal and arbitration law narrowly limits judicial review of IDR decisions. Highmark’s complaint attempts to navigate that constraint by arguing the disputed determinations were procured through fraud and that arbitrators exceeded their authority by issuing rulings on disputes that were ineligible for the IDR process in the first place.
“Four federal district courts have dismissed similar copy-paste litigation started by the Blue Cross Blue Shield cabal. Highmark’s lawfare is intended to intimidate doctors out of seeking fair reimbursement for the care they have already provided,” Patrick Velliky, chief external affairs officer at HaloMD, told Becker’s in a statement.
The Highmark lawsuit comes days after the Trump administration finalized a major overhaul of the IDR process, establishing a centralized disputes gateway, creating a federal payer registry, and cutting per-dispute administrative fees from $115 to $15. The IDR system has logged more than 5 million disputes since launching in 2022, far exceeding the 17,000 annual filings regulators originally projected, and generating at least $5 billion in costs. HaloMD is one of four groups — alongside TeamHealth, SCP Health and Radiology Partners — that have accounted for the majority of dispute filings, according to federal data.
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