CMS releases new NSA data; Media continues to draw attention to NSA provider abuses

The Centers for Medicare & Medicaid Services (CMS) released new data showing that the No Surprises Act’s (NSA’s) Independent Dispute Resolution (IDR) process produced $15B in provider payouts in 2025, an increase of over 300% from the $4B paid out in 2024, generating increasing calls for CMS to fix the process or for Congress to reform the underlying law.

The Q3 and Q4 2025 data had noticeable changes compared to the first half of 2025 (1H): the volume of disputes were 16% higher; the share of health care facilities initiating a dispute rose from 19% to 24%; providers prevailed in 85% of determinations; and the top ten initiating parties accounted for 66% of all disputes. In part due to advocacy efforts of the Coalition Against Surprise Medical Billing (CASMB), new provider abuse stories were highlighted in The Wall Street Journal, including an editorial, and The New York Times.

A CMS spokesperson was quoted in The New York Times as saying, “The system is being gamed to get higher prices, and CMS is actively working to clean it up.” The Cigna Group is partnering with CASMB and AHIP to leverage these findings, including reports of nine individual ER claims each exceeding $2M.