Insurer Anthem Blue Cross has -- for now -- lost a legal fight to have waves of high-dollar physician billing wins obtained through the No Surprises Act (NSA) independent dispute resolution (IDR) process vacated based on allegations of fraud, according to an April 9 California U.S. District Court decision.
Claims that the activities constituted violations of the Racketeering Influenced and Corruption Organizations (RICO) Act were also dismissed for lack of jurisdiction, according to the order.
Anthem maintained that the defendants, HaloMD (an IDR administrator), MPower Health, Bruin Neurophysiology, and other physician groups in California, manipulated the NSA IDR process by strategically submitting massive numbers of open negotiations and IDR initiations to prevent Anthem from contesting those claims.
In the ruling, U.S. District Judge Karen Scott found no basis for the district court to vacate any IDR determinations as requested.
"For now, though, this decision helps ACR members and their practices because it stopped a key payer’s efforts to use the courthouse to challenge the NSA dispute process that Congress and regulators established," said the American College of Radiology (ACR) April 20 when it highlighted the Central District of California court's ruling.
Anthem filed the lawsuit in July 2025. At the time, HaloMD President Alla LaRoque called a similar lawsuit filed by Blue Cross Blue Shield Healthcare Plan of Georgia "a calculated strike aimed at collapsing the IDR infrastructure so insurers can return to unilateral price‑setting."
If the court were to adopt the plaintiff's position, then nearly every eligibility determination disputed by an IDR participant would be subject to review in federal court, Scott said in her opinion coinciding with the judgment.
Anthem has filed a notice of appeal.
