Nutex Health Inc.
08/13/2026 | Press release | Distributed by Public on 08/13/2026 14:02
Material Event (Form 8-K)
Item 8.01 Other Events.
On August 11, 2026, the Fifth Circuit Court of Appeals issued an en banc decision in Texas Medical Association v. HHS, No. 23-40605, vacating key portions of the July 2021 interim final rule (July 2021 Rule) promulgated by the Departments of Health and Human Services, Labor, and Treasury (Departments). The vacated provisions had allowed the inclusion of "ghost rates" and excluded bonus and incentive payments from the calculation of the Qualifying Payment Amount (QPA) under the No Surprises Act (NSA). A majority of the en banc court ruled that insurers may not include so-called "ghost rates" in their QPA calculations and must include bonus and incentive payments.
Under the NSA, insurers and healthcare providers (such as Nutex Health Inc.) must negotiate reimbursement rates via a process that centers on the QPA, and if the parties cannot reach an agreement, they may submit the dispute to an independent resolution (IDR) arbitration process. The QPA, as described by the court, is the median of the total maximum rates in an insurer's contract for an item or service that a provider provides and furnishes, sorted by specialty and geographic region. The NSA authorized the Departments to refine the methods used to calculate the QPA via rulemaking.
The court upheld the district court's vacatur of the July 2021 Rule, which had allowed the inclusion of all rates appearing on the face of the insurer's contract, including non-negotiated placeholder rates for services a doctor never actually performs. The inclusion of such "ghost rates" artificially suppressed the resulting QPA and, according to the court, resulted in IDR arbitration results exceeding the QPA in 85% of arbitrations.
Further, the court held that the July 2021 Rule, which required insurers to exclude risk sharing, bonus, penalty, or other incentive-based or retrospective payments or payment adjustments, contravenes the plain text of the NSA and artificially deflates the QPA.
In accordance with the Administrative Procedure Act the court upheld the district court's vacatur of the July 2021 rule, directing the Departments to exercise their enforcement discretion to allow insurers to continue using their existing QPAs until new QPAs are calculated in accordance with new rules promulgated by the Departments consistent with the NSA.
Nutex Health Inc. published this content on August 13, 2026, and is solely responsible for the information contained herein. Distributed via EDGAR on August 13, 2026 at 20:03 UTC. If you believe the information included in the content is inaccurate or outdated and requires editing or removal, please contact us at [email protected]