Susman Godfrey secured a sweeping victory for clients LifeNet, Inc. and East Texas Air One, LLC, two Texas-based air ambulance providers, in their challenge of a federal rule regulating the amount insurance companies compensate emergency air carriers.
At issue in the lawsuit are several portions of the July 1, 2021 Rule issued by the U.S. Department of Health and Human Services and other federal agencies in implementing the No Surprises Act. The companies are part of a consolidated group of plaintiffs challenging portions of the rule.
LifeNet and East Texas Air One specifically challenged a regulation that extends the deadline for insurers to make an initial payment determination, a rule requiring two separate arbitration proceedings for a single air transport, and other air-ambulance-specific rules around calculating the qualifying payment amount (QPA), or the median rate the insurer would have paid for a service if provided by an in-network provider or facility. In his August 24 opinion, US District Judge Jeremy D. Kernodle of the Eastern District of Texas agreed these regulations were unlawful, noting the majority of the portions challenged by the consolidated group of plaintiffs “violate the plain text of the [No Surprises] Act.”
“We are thrilled to see yet another victory on behalf of providers that have been unfairly impacted by these rules,” said co-lead counsel and New York partner Steven Shepard. “The court has made an important ruling that takes significant steps toward ensuring these providers are adequately compensated for these critical services.”
This win was covered by Texas Lawyer in is story, Susman Godfrey Dismantles Federal Medical Billing Scheme (subscription required).
Joining Mr. Shepard on the matter is co-lead counsel and partner Stephen Shackelford as well as associates Max Straus and Craig Smyser.
The case is Texas Medical Association, et al. v. U.S. Dep’t of Health and Human Services, et al., No. 6:22-cv-450. Details on Susman Godfrey’s previous win on behalf of LifeNet and East Texas Air One can be found here.