A federal appeals court has struck down key parts of the formula that determines how much insurers must pay emergency physicians, anesthesiologists, and air ambulance crews when those clinicians are out of network, finding that regulators allowed insurers to build the benchmark partly from rates for services that were never actually performed.
The Fifth Circuit Court of Appeals, sitting en banc with its 17 active judges, issued the decision on August 11, 2026, in Texas Medical Association v. Department of Health and Human Services. The court vacated portions of a July 2021 interim final rule governing how insurers calculate the qualifying payment amount, or QPA, under the No Surprises Act. The case has a long history: a Texas district judge ruled against the government on ghost rates in 2023, a Fifth Circuit panel reversed that ruling the following year, and the full court then agreed to rehear it.
