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Originally published November 8, 2024
by National Alliance of Medical Auditing Specialties 

When the concept of “insurance discrimination” rears its ugly head, we often think of it in the context of when an insurance company treats some people differently than others based on protected classes, such as race, national origin, sex, or religion.  Sometimes, this type of discrimination occurs through underwriting guidelines, coverage denials, refusal to renew coverage, limiting coverage, or imposing artificial age limits on coverage.  However, there is another type of “insurance discrimination” that I find particularly fascinating – discrimination against certain types of providers.

In 2010, the United States experienced a dramatic change in healthcare regulations through the passage of the Affordable Care Act (“ACA”).  Of particular note, the ACA included a provision that prohibits discrimination by insurers against providers acting within the scope of their licensure. 42 U.S.C. § 300gg-5.  Of course, a payer is still permitted to establish varying reimbursement rates based on quality or performance measures.  Id.  When insurers violate the ACA, the United States Department of Health and Human Services (“HHS”) is obligated to take action. 42 U.S.C. § 300gg-22.  However, HHS has never enforced the provider nondiscrimination provision of the ACA in the 15 years since it was passed.

Further, the No Surprises Act, passed in 2022, requires HHS, the Secretary of Labor, and the Secretary of the Treasury to issue a proposed rule implementing the provider non-discrimination protections under the ACA. These were supposed to be proposed by Jan. 1, 2022, and implemented 6 months after the conclusion of the comment period. There has been no proposed rule yet... [Read More]

Read the full article by BMD Member Jeana M. Singleton as originally published by the National Alliance of Medical Auditing Specialties. If you have any questions about health law, you can contact Jeana at jmsingleton@bmdllc.com or 330.253.2001.