The Courthouse Door Is Closed: What the Aetna–Radiology Partners Ruling Means for Providers and Payers

By Elena Pak, Credentialing Department, WCH

A federal judge’s dismissal of Aetna’s fraud lawsuit against Radiology Partners last week is more than a single court loss for one major insurer. It is the second such dismissal in a matter of days, and together the two rulings are beginning to draw a clear jurisdictional line: disputes arising from the No Surprises Act belong inside the Independent Dispute Resolution process, not in federal court. For health system leaders — whether they sit on the provider or payer side — the implications touch billing strategy, compliance posture, contract structure, and the broader trajectory of a law that has already generated billions in unintended costs.

What Happened

Aetna, the CVS-owned insurer, first sued Radiology Partners in late 2024, accusing the imaging group of creating a scheme to extract higher reimbursement by routing claims through a subsidiary that no longer held an in-network contract with the insurer. The allegation was specific: Radiology Partners had initially funneled its Florida claims through the subsidiary because it had the most lucrative contracts with commercial payers in the state. When Aetna terminated that subsidiary’s in-network contract, the group continued billing through it anyway, filing tens of thousands of arbitration requests under the No Surprises Act — even for its in-network providers — in what Aetna described as a bid to systematically capture higher out-of-network rates through IDR.

Aetna sought to vacate Radiology Partners’ existing IDR awards, recover fees accrued in the dispute resolution process, and block further disputed claims not yet filed. On April 17, District Judge Brian Davis of the Middle District of Florida dismissed the case, ruling that the allegations, while presenting a close call, failed to establish sufficient basis to excuse Aetna from challenging the disputes through IDR itself rather than the courts.

One week earlier, a California judge dismissed a parallel case brought by Elevance’s Anthem subsidiary against billing intermediary HaloMD. That court similarly ruled that insurers should use the IDR process to convince arbiters that disputes are ineligible, rather than turning to litigation.

Radiology Partners called the outcome “the ruling makes clear that this lawsuit could not be used to unwind IDR outcomes after the fact.” Aetna declined to comment.

The IDR Machinery Behind the Case

To understand why these rulings matter, the scale of what has happened to the IDR system since the No Surprises Act took effect in 2022 is essential context.

Federal regulators anticipated the process would resolve roughly 17,000 disputes per year. The reality has been categorically different. From mid-2022 through June 2025, parties submitted 3.4 million disputes to the IDR portal — more than 60 times the projected annual volume over three years — and by the end of 2025, the total had grown to approximately 4.8 million. In the first half of 2025 alone, 1.2 million new disputes were filed, more than double the volume of the same period a year earlier.

A small number of providers, most of them private equity-backed, drive the overwhelming majority of these cases. Radiology Partners and its affiliates accounted for 28% of all disputes in 2023 and 2024. Team Health accounted for another 15%. Combined with HaloMD — a middleman organization that specializes in arbitration — these top players collectively dominate the docket. Providers initiate 99.9% of all disputes, and they win about 88%, the highest provider win rate recorded since the process launched. When providers win, median payment determinations now run at roughly 459% above the qualifying payment amount — the benchmark in-network rate — up from 327% just two years earlier.

Georgetown University researchers estimated that from 2022 through 2024, the IDR system generated at least $5 billion in total costs, roughly $2 to $2.5 billion per year. By mid-2025, the trajectory had accelerated sharply: in the first six months of 2025 alone, IDR administrative fees reached $844 million — nearly equal to the total accumulated over the preceding three years. This higher spending will be reflected in increased health costs and consumer premiums industry-wide.

Almost 40% of disputes submitted to IDR in 2024 were identified as ineligible by payers, yet many still advanced through arbitration. Only 17% of cases were ultimately deemed ineligible by IDR entities themselves, meaning more than half of the flagged ineligible cases still resulted in binding payment determinations.

What the Rulings Actually Establish

The two April dismissals do not vindicate Radiology Partners or HaloMD on the merits. Neither judge ruled that the alleged conduct was acceptable. What the courts said — consistently — is that the IDR process is the statutory venue for these disputes, and that insurers cannot route around it by bringing fraud allegations to federal court after IDR awards have already been issued.

That interpretation creates a structural bind for payers. The IDR system was built for individual billing disputes, not for adjudicating systemic claims of process manipulation. Using it to challenge thousands of allegedly ineligible claims requires identifying and contesting each one individually — an operationally intensive task that, given processing delays and a median determination time still running at 81 days per claim, is ill-suited to addressing patterns of abuse at scale.

The ruling does not eliminate payers’ legal options entirely. Courts may still be appropriate venues for certain RICO or contract-based theories that do not require unwinding individual IDR awards. And the broader litigation wave is not receding: as of early 2026, there are at least nine formally tracked lawsuits from payers against high-volume IDR participants, with additional cases pending against most of the entities responsible for the majority of dispute submissions.

What Providers Should Do Now

Audit your IDR eligibility practices rigorously. The single most consequential near-term risk for provider groups — especially those with large out-of-network billing operations or subsidiary structures — is submitting claims that are ineligible for IDR. Nearly 40% of payer-identified ineligible claims still generate arbitration proceedings, but the legal and reputational exposure is rising sharply. Even where claims advance and providers win, the pattern of high-volume ineligible submissions is now the basis for both litigation and legislative reform proposals.

Review subsidiary and billing entity structures. The Aetna complaint focused precisely on how a subsidiary structure was used to access the IDR process for claims that would otherwise be in-network. Health systems and physician groups with complex multi-entity structures should review whether their billing pathways are aligned with the spirit as well as the letter of the NSA — particularly in light of ongoing judicial and regulatory scrutiny.

Do not assume litigation protection will hold. The dismissals are a short-term win for providers, but they rest on procedural grounds, not a substantive endorsement of high-volume IDR use. Congress is actively examining IDR reform; the regulatory environment could shift abruptly. Strategies built on sustained IDR volume as a reimbursement lever carry long-term political and legal risk that is increasing, not decreasing.

Strengthen in-network contract negotiations. The underlying reason payers are litigating is that IDR awards are coming in at three to nine times in-network rates. The most durable protection against both litigation exposure and regulatory backlash is to build in-network contract rates that reflect genuine market value, reducing the financial incentive for either side to treat arbitration as a primary revenue strategy.

Track the legislative horizon. Multiple reform proposals are circulating that would tighten IDR eligibility criteria, increase oversight of high-volume initiators, and change the fee structure for IDR entities. Provider groups and their government affairs teams should engage in these processes now, while the regulatory framework is still being shaped, rather than after rules have been finalized.

***

The No Surprises Act succeeded at its core patient-protection goal. Research published in the BMJ found the law tied to an 18% decline in out-of-pocket spending among patients, saving families an average of $567 annually. But the IDR mechanism that Congress attached to it has become something different from what was envisioned — a high-volume, PE-driven arbitration industry that generates billions in system costs and has made the law a source of sustained conflict between payers and providers.

The courthouse door, at least for post-hoc fraud claims, is now effectively closed. What remains open is the IDR process itself, the legislative agenda, and the contracting table. Providers who want long-term operating stability need to engage seriously with all three.

Sources

1. Healthcare Dive, April 20, 2026 — Judge dismisses Aetna’s No Surprises fraud suit against Radiology Partners. healthcaredive.com
2. Healthcare Dive, April 14, 2026 — California judge tosses Elevance’s surprise billing suit in win for providers. healthcaredive.com
3. Healthcare Dive, January 26, 2026 — No Surprises disputes increasing even as arbiters catch up, CMS says. healthcaredive.com
4. Health Affairs / Georgetown University Center on Health Insurance Reforms, August 2025 — The Substantial Costs of the No Surprises Act Arbitration Process. healthaffairs.org
5. Health Affairs / Georgetown CHIR, 2026 — The No Surprises Act IDR Process: An Early Look at 2025 Data. healthaffairs.org
6. Fierce Healthcare, August 2025 — No Surprises Act dispute resolutions have driven $5B in costs, study finds. fiercehealthcare.com
7. AHIP / BCBSA, October 2025 — New AHIP/BCBSA Survey Shows Nearly 40% of Providers’ Surprise Billing Disputes Are Ineligible Under No Surprises Act. ahip.org
8. MedCity News, March 2026 — ‘This is Crazy’: Health Experts Call for Changes to the No Surprises Act. medcitynews.com
9. Becker’s Payer Issues, January 2026 — 11 No Surprises Act Updates. beckerspayer.com