Fifth Circuit Cites Unlawfully Calculated QPAs as Key Driver of No Surprises Act Problems

Federal Court Ruling Will Require Insurers to Accurately Calculate QPAs; Exclude "Ghost Rates" Artificially Lowering the Median In-Network Payment Amount

DALLAS, Aug. 12, 2026 /PRNewswire/ -- HaloMD applauds the opinion issued Tuesday in Texas Medical Association v. HHS (TMA III) by the U.S. Court of Appeals for the Fifth Circuit. The long-awaited en banc decision confirms what physicians and clinicians already know about the No Surprises Act's Qualifying Payment Amount (QPA): it's a flawed calculation that has allowed insurers to justify low-ball payments for necessary medical care.

The court made clear that the previous administration missed the mark when issuing the regulations implementing the QPA methodology, which was intended by Congress to reflect the median in-network rate for an out-of-network service. In the majority opinion, the court wrote plainly: "Plaintiffs contend that this rule contravenes the plain text of the NSA and artificially deflates QPA calculations. We agree."

"QPAs have been completely detached from reality since the earliest days of the No Surprises Act," said Alla LaRoque, president and chief executive officer of HaloMD. "More honest and transparent QPA calculations will lead to durable networking agreements and sustainable access to care in communities across the country."

The flawed QPA methodology was identified by the court as having "upended the NSA's dispute-resolution process." It stated, "[b]ecause the agencies directed insurers to include non-negotiated ghost rates, the resulting QPAs were artificially low."

"Physicians are being forced to spend as much time fighting predatory insurance practices as they do caring for patients," said Patrick Velliky, chief external affairs officer of HaloMD. "For years, insurers have systematically underpaid doctors using QPAs that don't pass the laugh test. The Fifth Circuit just took away one of their tools to do it."

About HaloMD

HaloMD is the No. 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 and long-term financial sustainability while empowering care teams to focus on providing high-quality patient care.

Privately held and founder-led, HaloMD serves more than 25,000 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.

SOURCE HaloMD