Court Rejects Insurer Claims, Suggests Insurers Use “Lowball Offers” to Maximize Profits
DALLAS, July 13, 2026 /PRNewswire/ — HaloMD today celebrates its third consecutive legal victory against insurers’ coordinated campaign to intimidate providers through frivolous litigation. Judge Thomas W. Thrash, Jr., of the U.S. District Court for the Northern District of Georgia, dismissed with prejudice every single claim brought by Blue Cross Blue Shield Healthcare Plan of Georgia (BCBS Georgia) against HaloMD and one of the provider groups it represents.
The Court categorically rejected BCBS Georgia’s attempt to weaponize federal and state law to collaterally attack HaloMD, the provider community, the No Surprises Act (NSA), Independent Dispute Resolution Entities (IDREs) and the legally binding awards issued under Independent Dispute Resolution (IDR).
Further, the Court went far beyond dismissing the insurer’s claims — it dismantled the premise itself, concluding that high provider win rates are not evidence of fraud but, more plausibly, evidence of the insurer making systematically low payment offers to providers.
“The Court notes that the Plaintiff argues that it loses a lot of IDR arbitrations. For example, it says that of the 228 IDRs the Defendants initiated on May 3, 2024, the Plaintiff lost 192. It cites CMS data that Providers prevailed in 85% of IDR payment determinations. It is highly improbable to infer from these facts that there is a vast conspiracy of providers and IDREs that have conspired to defraud the Plaintiff of millions of dollars in thousands of NSA IDR proceedings over many years. It is highly plausible to infer that the Plaintiff engages in a consistent practice of submitting lowball offers to out-of-network providers in an effort to maximize its profits.”
The Court identified the fraud and RICO framing as nothing more than an attempt to recoup money lawfully awarded to providers through the IDR process.
“…it is overwhelmingly clear to this Court that the main purpose of the RICO claims is to collaterally attack the IDR awards.”
This is the third near-identical lawsuit filed by insurers that has been dismissed against HaloMD and its provider clients. Insurers have deployed a coordinated playbook designed to intimidate providers, burden them with costly litigation and coerce them into accepting low payments.
“These cases were never about HaloMD,” said Alla LaRoque, President of HaloMD. “It was part of a broader effort to convince the courts and Congress that provider success in IDR must mean the system is broken. Today, the Court rejected that premise. Organizations that have believed payer allegations should stop asking if this system is broken and start asking why payers are trying to break it.”
“Insurers have argued that providers’ win rate proves the system is broken,” said Patrick Velliky, Chief External Affairs Officer of HaloMD. “The Court reached the opposite conclusion: persistent losses by insurers are consistent with low offers. That explanation, along with an insurer arbitration default rate of more than 25%, deserves scrutiny.”
Timeline
On April 9, 2026, Judge Karen E. Scott of the U.S. District Court for the Central District of California dismissed all claims brought against HaloMD by Anthem Blue Cross of California with prejudice, ruling that Plaintiffs’ theories were “all end runs around the NSA limits on judicial review.” Anthem alleged that HaloMD and a network of providers operated coordinated criminal enterprises that exploited the IDR process, bringing claims under federal RICO, wire fraud and California Unfair Business Practices.
On May 22, 2026, Judge Robert W. Schroeder of the U.S. District Court for the Eastern District of Texas dismissed every claim brought by Blue Cross Blue Shield of Texas against HaloMD with prejudice, finding BCBS Texas’s claims were “cloaked in a variety of federal and state law claims,” and amounted to “no more than a collateral attack” on the IDR awards. BCBS of Texas targeted HaloMD and its leadership, alleging that HaloMD was flooding the IDR system.
The third dismissal was in Georgia, where BCBS Georgia was the first insurer to file now-dismissed legal action against HaloMD in May 2025. The insurer claimed that HaloMD had orchestrated a scheme to inundate the IDR system with ineligible disputes. On July 10, 2026, the Court dismissed all claims with prejudice. Importantly, the Court dismissed the notion that high provider win rates signaled fraud, instead finding it “highly plausible to infer that the Plaintiff engages in a consistent practice of submitting lowball offers to out-of-network providers in an effort to maximize its profits.”
About HaloMD
HaloMD is the #1 provider of Independent Dispute Resolution (IDR) services as indicated by public CMS data, backed by industry leading technology infrastructure and data intelligence. The company supports healthcare providers navigating the federal No Surprises Act and state balance-billing laws, combining proprietary technology, advanced analytics, and deep specialty expertise to advance fair reimbursement, long-term financial sustainability, and empowering care teams to focus on providing high quality patient care.
Privately held and founder-led, HaloMD serves more than 20,000 providers, from independent physicians to hospitals and health systems, across 50 states and Washington, D.C., so they can continue caring for the patients and communities they serve.
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SOURCE HaloMD
