On September 17, the U.S. Court of Appeals for the Second Circuit handed down a fantastic ruling for payors defending against private enforcement of No Surprises Act (NSA) independent dispute resolution (IDR) payment determinations. In East Coast Advanced Plastic Surgery, LLC v. Cigna Health & Life Insurance Co., the court held that the NSA does not create a private right of action allowing out-of-network providers to sue health plans that fail to pay IDR payment determinations.
On September 8, the Department of Labor’s Employee Benefits Security Administration (EBSA) issued Field Assistance Bulletin No. 2026-03, outlining how it will enforce the Mental Health Parity and Addiction Equity Act’s (MHPAEA) nonquantitative treatment limitation (NQTL) requirements going forward. The bulletin follows through on EBSA’s January 2026 announcement identifying mental health/substance use disorder (MH/SUD) benefit barriers as a national enforcement priority, and responds to sustained industry complaints that prior NQTL enforcement and comparative analyses requirements created confusion and unnecessary compliance burdens.
In a significant en banc decision issued on August 11, 2026, the U.S. Court of Appeals for the Fifth Circuit largely affirmed a district court ruling that invalidated key portions of the federal agencies’ rules governing the calculation of the “qualifying payment amount” (QPA) under the No Surprises Act (NSA). The court’s decision has major implications for how insurers calculate the benchmark rate at the center of the NSA’s independent dispute resolution (IDR) process.
In this episode of The Consumer Finance Podcast, Chris Willis is joined by Troutman Pepper Locke Partners Stefanie Jackman and Brent Hoard to take a close look at the world of medical debt collection. The discussion covers how HIPAA applies to medical debt, what it really means to be a “business associate,” and common privacy challenges that can turn routine collection efforts into regulatory headaches. They also focus on key federal and state debt collection regimes, including the FDCPA, the No Surprises Act, and increasingly complex credit reporting requirements. The group provides insight on collection strategies for health care providers and third-party collectors that are both compliant and workable in practice. For anyone handling medical-related receivables, this episode serves as a practical guide to safeguarding patient information, maintaining tax-exempt status, and enhancing collections while staying within regulatory boundaries.
Recently, the Sixth Circuit issued a significant ERISA preemption ruling for employers and pharmacy benefit managers (PBMs). The court held that Tennessee’s PBM laws, which require “any willing” pharmacy access and limiting incentives that steer members to plan‑favored pharmacies, are preempted as applied to self‑funded ERISA plans. The ruling draws a clear line between permissible PBM cost regulation and impermissible interference with plan design and administration.
The Fourth Circuit has affirmed a preliminary injunction barring enforcement of West Virginia’s S.B. 325, which sought to restrict how drug manufacturers implement contract pharmacy policies under the federal 340B Drug Pricing Program. In a published decision, the court held that manufacturers are likely to succeed on their claim that S.B. 325 is preempted because it impermissibly rewrites the “bargain” Congress struck with manufacturers under its spending power and interferes with the Health and Human Services’ (HHS) exclusive enforcement role.
On March 20, Federal Trade Commission (FTC) Chairman Andrew N. Ferguson issued a memorandum directing the creation of an internal Healthcare Task Force. The directive underscores that healthcare remains a top enforcement and policy priority for the FTC, reflecting the Administration’s focus on a “more competitive, innovative, affordable, and higher quality healthcare system.”
In our January 14 blog, we explained that Chief Judge Lance Walker of the U.S. District Court for the District of Maine had entered a nationwide preliminary injunction in American Hospital Association v. Kennedy, blocking the Health Resources and Services Administration’s (HRSA) 340B Rebate Model Pilot Program under the Administrative Procedure Act (APA). We also noted that both the district court and the First Circuit denied the government’s requests for a stay, and that the U.S. Department of Justice (DOJ) told the First Circuit the parties planned to dismiss the appeal and consider sending the approvals back to HRSA.
In an unpublished memorandum decision, the Ninth Circuit in R.R. v. California Physicians’ Service d/b/a Blue Shield of California, affirmed the insurer and administrator’s denial of benefits for a dependent’s residential mental health treatment under an ERISA‑governed plan. The court applied abuse‑of‑discretion review and concluded that the denial was supported by the plan’s medical‑necessity criteria and the administrative record. The dissent, however, argued that the majority failed to meaningfully account for a structural conflict of interest and for the administrator’s handling of treating‑provider evidence and prior failed lower levels of care.
On January 26, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) capitation rates and Medicare Part D payment policies. CMS projects a net average year‑over‑year MA payment change of just 0.09% — roughly a flat environment once medical trend, utilization, and other pressures are considered. CMS frames the proposal as improving “payment accuracy and sustainability,” with a focus on aligning payments more closely with actual beneficiary risk and care rather than documentation intensity.