PRNewsWire
25 Aug 2026, 09:30 UTC · 2h ago
Fifth Circuit Rejects "Ghost Rates" in Federal QPA Calculations Under the No Surprises Act
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PRNewsWire
25 Aug 2026, 09:30 UTC · 2h ago
NewsImpactScreener rates every claim in this story for market impact and maps it to the tickers most exposed.
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The Fifth Circuit Court of Appeals invalidated federal rules that allowed insurers to use 'ghost rates' (low placeholder rates) to deflate the Qualifying Payment Amount (QPA) under the No Surprises Act. — This removes a mechanism that artificially lowered reimbursement rates, likely increasing revenue for healthcare providers like Nutex Health.
+0.60The court ruled that insurers must include bonus and incentive payments in the 'total maximum payment' calculation used for the QPA. — Including these payments will further increase the QPA benchmark, leading to higher baseline payments to providers.
+0.40Current enforcement relief allows insurers to continue using the old QPA methodologies for services furnished before October 1, 2026. — This creates a lag in the financial benefit, delaying the immediate realization of higher payments for providers.
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The ruling focuses exclusively on disputes between insurers and providers and does not change patient cost-sharing protections. — This is a neutral point ensuring that the ruling does not introduce new liabilities for patients or change consumer behavior.
+0.00Which stocks this story touches
The company applauds a court ruling that removes 'ghost rates' which had artificially deflated payments to healthcare providers.
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