New Audit by The Phia Group Flags Provider Billing Strategies Driving Employer Plan Waste Under the No Surprises Act (NSA)

New state-by-state analysis reveals how NSA arbitration dynamics are fueling aggressive costs for employer-sponsored health plans

CANTON, Mass., March 12, 2026 /PRNewswire/ -- The Phia Group, one of the nation's leading healthcare cost containment firms, today released The Phia Group's National NSA Report on Aggressive Provider Billing that exposes systemic billing patterns and arbitration strategies under the No Surprises Act (NSA) that are driving up unnecessary costs for employers -- often without patients ever seeing the bill.

Using more than 1.25 million federal arbitration disputes and data from over 23,000 healthcare providers, the report ranks states by the prevalence of providers engaging in high-offer and high-billing behaviors. A subsequent pattern suggests there is strategic positioning to inflate Independent Dispute Resolution (IDR) outcomes at the expense of employer-sponsored health plans.

"The No Surprises Act was designed to protect patients, not to create a new revenue strategy for providers," said Scott Bennett, Esq., Chief Provider Relations Officer at The Phia Group. "Our analysis shows that in many states, arbitration has become a tool for extracting higher payments from employer plans, undermining the law's intent and increasing healthcare waste."

To assess provider behavior under the NSA, The Phia Group categorized providers using a four-tier classification system based on relative billing ratios and IDR offer levels. Providers were classified as: Category 1=relatively low billing ratio, low end of IDR offers; Category 2=relatively high billing ratio, low end of IDR offers; Category 3=relatively high billing ratio, high end of IDR offers; and Category 4=relatively low billing ratio, high end of IDR offers.

Key Findings: Nevada Emerges as the Highest-Risk State

Nevada stands out as the most extreme example of having aggressive provider behavior nationwide. Fifty-six percent of Nevada providers analyzed (42 of 75) fall into the highest-risk categories, classified as Category 3 and 4, the largest share of any state in the dataset.

Additional findings include:

• Clusters of elevated risk proportions of Category 3 and Category 4 providers appear across several states, including:
  • South Carolina (43%)
  • Arkansas (42%)
  • Louisiana (41%)
  • Colorado (40%)
• Tennessee is a major dispute volume driver, with 147 providers generating 36,116 disputes, while still showing a relatively high Category 3 and Category 4 share (31%, 46 providers).
• Large states show moderation but still significant incidence of Category 3 and Category 4 providers:
• • Texas: 181 providers (24%)
  • Florida: 335 providers (22%)
  • New York: 123 providers (23%)
• Lower-risk states include:
  • Michigan (14%)
  • Pennsylvania (13%)
  • Indiana (13%)
  • Illinois (10%)
  • Wisconsin (9%)
• Provider count and dispute volume don't always align:
  • States like South Carolina and Virginia show disproportionately high dispute counts relative to provider numbers, suggesting that disputes may be concentrated among a small group of aggressive providers.

To download a full report, including key findings and a state-by-state ranking list, visit www.phiagroup.com/media/posts/national-nsa-report/.

Why It Matters for Employers, Brokers and Advisors

The patterns identified in the report indicate that some providers may be using elevated offer strategies to influence arbitration outcomes, and ultimately, driving awards above reasonable payment levels and increasing employer plan costs without improving patient protection.

"Brokers and advisors are on the front lines of helping employers manage healthcare costs and navigate an increasingly complex regulatory landscape," said Adam Russo, CEO of The Phia Group. "This audit underscores how critical it is for these professionals to look beyond surface solutions and partner with experts who can truly unpack cost drivers like arbitration behavior. At Phia, we work closely with our partners to bring deep data insight, compliance support, and actionable strategies that protect employer plans and deliver real savings—helping them add real value for their clients in a market where transparency and cost control matter more than ever."

For brokers and advisors that are interested in more information about The Phia Group, please contact [email protected].

Methodology
The Phia Group's National NSA Report on Aggressive Provider Billing combined publicly available CMS IDR Excel reports from 2023 and 2024, removing entries without valid provider identifiers (NPIs) or offer metrics. The data was aggregated by provider and location to calculate average IDR offer measures. The dataset was enriched with professional and facility billing ratios from other CMS public sources, with each provider's billing normalized against their state's median. Offer and billing metrics were converted into percentiles, providers were classified using percentile-based cutoffs, and results were mapped by ZIP code to produce a color-coded, state-level visualization of provider behavior.

• Total disputes analyzed: 1,256,822
• Total unique providers: 23,585
• Providers with complete billing data used for mapping: 11,738

About The Phia Group
The Phia Group empowers health benefit plans and sponsors through innovative consulting, cost containment, and plan management services. Founded in 2000, Phia reduces the cost of health benefits and improves access to quality care through innovative technologies, legal expertise, and focused, flexible customer service. By providing the industry with best practices and staying true to a forward-thinking methodology, The Phia Group boasts an all-encompassing cost containment program for the ever-changing healthcare industry. Learn more at phiagroup.com.

SOURCE The Phia Group, LLC