Elevance Health’s Blue Cross Blue Shield of Georgia is suing HaloMD, Hospitalist Medicine Physicians of Georgia and Sound Physicians Emergency Medicine of Georgia, alleging the three organizations exploited the No Surprises Act’s Independent Dispute Resolution process for financial gain.
The lawsuit was filed May 27 in the District Court for the Northern District of Georgia and claims that the companies knowingly submitted thousands of ineligible disputes through the IDR process, with false claims of eligibility, in an effort to receive inflated reimbursement payments.
“Through this scheme, defendants procured improper payments from BCBSGA on thousands of disputes. Indeed, nearly 70% of disputes on which defendants received an IDR payment determination were clearly ineligible for the process,” the lawsuit says. “Since 2024, defendants’ scheme has caused millions of dollars in damages, and it continues to harm BCBSGA, employer plan sponsors, and other managed care companies.”
The No Surprises Act protects consumers from surprise medical bills by requiring a neutral third-party arbitrator to resolve payment disputes between insurers and out-of-network providers.
According to the complaint, the companies submitted large volumes of disputes that exceeded market rates. In many cases, the arbitration awards allegedly exceeded what the providers could have reasonably charged for the services. Between January 2024 and April 2025, Elevance estimates that the scheme resulted in $5.9 million in improper payments and arbitration fees.
Elevance is asking the court to vacate the improperly obtained IDR awards, halt further alleged fraudulent practices, and return the excess payments. The payer also wants the court to declare the defendants’ actions unlawful under the RICO Act.
“HaloMD categorically denies all allegations and claims made against it in the lawsuit and will vigorously defend itself,” a spokesperson told Becker’s.
