Elevance Health, parent company of Blue Cross Blue Shield of Georgia, has filed a lawsuit against billing company HaloMD and two physician groups accusing them of exploiting the federal arbitration system established under the No Surprises Act, according to court documents accessed by Becker’s.
Filed May 27, the lawsuit accuses Hospitalist Medicine Physicians of Georgia and Sound Physicians Emergency Medicine of Georgia of submitting thousands of ineligible disputes through the federal Independent Dispute Resolution process. According to the lawsuit, the disputes were falsely certified as eligible and structured to maximize payments well above market rates. Nearly 70% of disputes that resulted in payments to the providers were allegedly not qualified for arbitration.
Between January 2024 and April 2025, Elevance estimates the scheme led to $5.9 million in improper payments and arbitration fees. The payer argues that some claims should have been resolved under Georgia’s state-level protections against surprise billing, and that the providers improperly bundled claims and violated mandatory cooling-off periods.
In a statement shared with Becker’s, HaloMD has denied all allegations and said it will “vigorously defend itself” in court. The company emphasized that it complies with IDR requirements and noted that recent federal data shows providers prevail in the majority of IDR cases.
“Despite the framework’s clearly defined structure and oversight mechanisms, certain payers have adopted tactics that create unnecessary confusion, increase administrative burden and undermine the integrity of the process,” the statement said. “In HaloMD’s experience, these tactics have not served to prevent misuse — they have functioned as deterrents to legitimate provider participation.”
HaloMD further alleges that payers routinely apply Remark Code N830, which states that “charges for this service were processed in accordance with federal/state balance/surprise-billing regulations,” without specifying jurisdiction or plan type.
“This catch-all disclaimer forces providers to file under both state and federal IDR statutes to preserve eligibility, resulting in increased administrative burden, delayed resolution and widespread confusion,” the statement continued. “This tactic by payers has been widely criticized as a means of avoiding transparency and frustrating the intent of the IDR process.”
These patterns of behavior reflect not a concern for proper use of the IDR process, but resistance to a mechanism established by Congress to resolve disputes fairly, independently, and efficiently.
Elevance is seeking to vacate the contested IDR awards, recover funds and obtain a court ruling that the defendants violated the federal Racketeer Influenced and Corrupt Organizations Act.
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