September 9, 2025
The Coalition Against Surprise Medical Billing (CASMB), which represents employer groups, unions, and health insurers, sent a letter to the Trump administration strongly opposing a recent application by a private equity firm to become a Certified Independent Dispute Resolution (IDR) Entity under the terms of the No Surprises Act.
In the letter, CASMB writes that Guidehouse Inc., which is owned by Bain Capital (a private equity firm with extensive health care investments including provider groups), “raises material concerns about conflicts of interest and the integrity of the IDR process… Allowing a Bain-owned entity to arbitrate out-of-network disputes would be tantamount to having the fox guard the hen house.” The scale of private equity-backed providers in IDR disputes underscores these concerns.
According to data from the Centers for Medicare & Medicaid Services, in the first half of 2024, 47% of all cases originated from just four private equity-backed organizations and 45% of filed cases were challenged as ineligible, highlighting the systemic manipulation of the process by these entities.
CASMB notes that allowing Guidehouse to be certified in the role of a neutral arbiter is incompatible with the intent of the No Surprises Act. The Coalition is urging the administration to reject Guidehouse’s application.
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