The Trump administration formally canceled agreements with Island Peer Review Organization and Network Medical Review Company after they did not satisfy performance baselines. Neither organization is allowed to accept new payment dispute assignments moving forward, although each entity retains the right to submit an appeal. This administrative decision emerged after an investigation into the No Surprises Act revealed that appointed arbiters made large profits while frequently favoring medical providers in payment decisions.
Key points
Two prominent arbiters have been barred from taking new No Surprises Act payment dispute…: Two prominent arbiters have been barred from taking new No Surprises Act payment dispute cases.
Both disqualified organizations maintain the legal right to appeal the government's termi…: Both disqualified organizations maintain the legal right to appeal the government's termination decision.
Federal action follows public scrutiny into arbiter profitability and systematic patterns…: Federal action follows public scrutiny into arbiter profitability and systematic patterns of ruling for healthcare providers.
Sources checked by our analysis pipeline: 1
WASHINGTON — The Trump administration is cutting off two groups tasked with arbitrating disputes over surprise medical bills, citing a failure “to meet minimum performance standards.”
The groups, Island Peer Review Organization, or IPRO, and Network Medical Review Company, will no longer be able to accept new disputes, the government said in a Wednesday announcement. The firms can appeal the decision.
The decision comes after a STAT investigation found IPRO, as well as other arbitrators tasked with executing the No Surprises Act, were racking up huge profits while frequently deciding in favor of clinicians in the disputes.
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