Adjudicators are swamped with No Surprises Act claims, many of them frivolous, HHS Secretary Xavier Becerra told the Senate Finance Committee.
At a March 22 hearing, Sen. Michael Bennet, a Colorado Democrat, said he believes HHS is not implementing the law as Congress intended.
"We're seeing lawsuit after lawsuit from providers; insurers aren't responding in a timely manner, or sometimes not at all; and even when the payment determinations are won by providers, payers still don't pay providers after the statutory deadline," Mr. Bennet said.
"It's a big mess," he added.
The agency recently resumed No Surprises Act determinations, after pausing them in early February following a federal court decision in Texas that ruled the arbitration process favors insurers.
Mr. Becerra said the agency has received more than 10 times as many No Surprises Act claims than it expected when the law was first implemented. Many of these claims are frivolous, he said, because there is no cost to payers or providers to file a claim.
"Everyone's just filing all sorts of claims, and these arbitrators are trying to figure out what cases to handle," Mr. Becerra said. "That's what's bogging down the system.
The agency is staying true to Congress' intent with the law, Mr. Becerra said, but more legislative action is needed to deal with the high number of claims.
"What we're trying to do is have a system that works. I plead with you to help us make sure that we get to the legitimate cases, so a provider that's looking for real payment, or an insurer that's saying, You're asking for too much,' we can adjudicate that," Mr. Becerra said.