Virginia Federal Court Reinforces Narrow Review of No Surprises Act IDR Awards

What did the court decide in Anthem v. AGS Health?

The U.S. District Court for the Western District of Virginia dismissed the complaint with prejudice, reinforcing that judicial review of federal No Surprises Act IDR determinations is exceptionally narrow. The court concluded that Anthem could not use RICO, ERISA, fraud, conspiracy, or related theories to obtain broader review of eligibility and payment determinations.

For Counts I–VIII and X, the court concluded that the claims operated as collateral attacks and that lack of subject-matter jurisdiction barred the federal challenges; it declined supplemental jurisdiction over the remaining state-law claims. Count IX, the alternative request to vacate the awards, failed to state a plausible basis for vacatur under the Federal Arbitration Act.

What did Anthem allege?

Anthem alleged that provider groups, a staffing organization, and a revenue-cycle company submitted large numbers of disputes that should have been governed by Virginia law rather than federal IDR. The complaint asserted that eligibility attestations were false, claimed the process had been manipulated, and sought relief from awards Anthem considered improperly obtained.

The court did not decide that those accusations were true. Instead, it examined whether Anthem could use those theories to challenge IDR determinations in federal court and whether the complaint plausibly alleged one of the narrow statutory grounds for vacatur.

Why did the collateral claims fail?

The court treated eligibility as part of the certified IDR entity's determination. Because Anthem's RICO, ERISA, fraud, and related theories depended on a court finding that the IDREs wrongly accepted the disputes and issued improper payment determinations, those claims would have required the court to revisit matters Congress placed within the IDR process.

The opinion reasoned that parties cannot avoid the No Surprises Act's limits on judicial review by placing a different statutory or common-law label on a challenge to the resulting awards. The court therefore rejected the non-vacatur theories as impermissible collateral attacks.

Why did the vacatur claim also fail?

Anthem separately invoked two Federal Arbitration Act grounds: that awards were procured by fraud or undue means, and that the IDREs exceeded their powers by deciding disputes that allegedly were not eligible for federal IDR.

The court found the fraud theory insufficient because the alleged eligibility issues were discoverable—and, according to the complaint, were actually raised—during the IDR proceedings. It found the excess-of-powers theory insufficient because federal regulations expressly assign certified IDR entities the task of deciding whether federal IDR applies. An IDRE does not exceed its authority merely by performing that assigned eligibility review.

Halkovich Law's commentary

The decision draws a meaningful boundary around post-award litigation. A plan cannot obtain a second, broader merits review simply by recasting dissatisfaction with an eligibility or payment determination as racketeering, fraud, or an ERISA violation.

That does not make providers immune from eligibility rules. The opinion instead makes careful eligibility screening and a complete administrative record more important. Providers should be prepared to support why each item or service belongs in federal IDR, particularly where a state payment law may apply. Plans likewise must present known eligibility objections through the IDR process rather than reserve them for collateral litigation after an unfavorable result.

The ruling strengthens the principle of IDR finality at the district-court level, but it does not bind every court nationwide. It also does not eliminate the Federal Arbitration Act's narrow vacatur grounds when properly supported by the facts.

What should providers take from the decision?

• Confirm federal IDR eligibility before initiating each dispute, including whether state law controls the payment methodology.
• Preserve the claim, plan information, eligibility analysis, open-negotiation record, and IDR initiation materials.
• Respond directly to eligibility objections and retain the evidence submitted to the certified IDR entity.
• Keep the eligibility decision, payment determination, proof of receipt, payment deadline, and final payment record together.
• Track later proceedings because this is a district-court decision and appellate treatment may change the governing analysis.

Frequently asked questions

Source and scope

This article summarizes the court's September 30, 2026 memorandum opinion and provides Halkovich Law's general provider-side commentary. It does not independently resolve the complaint's disputed factual allegations, predict appellate treatment, or provide advice for a specific claim.