Trump Administration Moves to Oust Arbitrators as Doctor Payouts Soar

The federal government plans to end contracts with two arbitration firms that settle medical billing disputes under the No Surprises Act, a consumer protection law that has come under scrutiny for high payouts for doctors.Congress passed the law in 2020 to protect patients from surprise bills when they saw a doctor who did not have a contract with their health plan, such as in emergencies.The law, which took effect in 2022, calls for health care providers and insurers to settle on a price and when they cannot, for arbitrators to review an offer from each side, and pick one.When the law passed, its authors expected the system to be used rarely and decisions generally to be split between the sides.

But doctors have flooded the system with millions of cases and have prevailed overwhelmingly, winning more than 85 percent of them in 2025, according to the most recent federal data.Many have received awards dozens of times higher than usual insurer rates.One New York plastic surgery practice won $440,000 for breast reduction surgeries in arbitration, The New York Times previously reported, and a surgical assistant in New Jersey won $106,500 for assisting on lower back surgery.The law has been a financial boon for the arbitration firms as well.

The government contracts with 17 firms to handle the millions of cases that now flow through the arbitration process.The arbitrators set their own fees, earning $425 to $800 for each dispute they settle, and they have collectively earned $742 million between 2022 and 2025.While the contractors are all supposed to follow the same rules, federal data shows that outcomes vary dramatically between the arbitrators....