Profiting on all sides: Private equity and the No Surprises Act

The document argues that private equity firms have systematically exploited the No Surprises Act's independent dispute resolution (IDR) process to increase healthcare costs. It details how private equity-backed groups lobbied for the arbitration provision via dark money campaigns and subsequently dominated the IDR process as both providers filing claims and certified entities arbitrating them. This has resulted in an estimated $5 billion in additional costs over three years, which the report suggests will lead to higher insurance premiums for patients.

• The independent dispute resolution (IDR) process established by the No Surprises Act has resulted in an estimated $5 billion in additional costs during its first three years of implementation. This total includes $2.24 billion in payment amounts, $1.9 billion in internal costs for plans and providers, $656 million in IDR entity fees, and $228 million in administrative fees.
• Private equity-backed providers have heavily utilized the IDR process, far exceeding federal expectations. In the nine months following the 2022 opening, approximately 190,000 disputes were filed, more than ten times the annual estimate of 17,333 claims. Two specific private equity-backed organizations, TeamHealth and Radiology Partners, filed 43% of resolved line-item claims in 2023 and 2024.
• Private equity firms have influenced the legislation through the dark money group Doctor Patient Unity, which spent at least $57 million on advertisements by April 2020 to advocate for the arbitration provision. This group was primarily funded by private equity-backed companies TeamHealth and Envision.
• Private equity firms have a significant presence on the arbitration side of the process, backing at least five of the 15 certified IDR entities as of October 2025. These include Acentra Health (backed by The Carlyle Group), Livanta, LLC, and subsidiaries of ExamWorks Group (MCMC Services and Network Medical Review Company), which is owned by CVC Capital, Leonard Green & Partners, and GIC.
• Potential conflicts of interest exist because some private equity firms invest in both the providers initiating IDR claims and the entities arbitrating them. For example, Leonard Green & Partners owns both the certified IDR entities under ExamWorks Group and North American Partners in Anesthesia (NAPA), a company that initiates IDR cases.
• The IDR process frequently results in payments to providers that exceed in-network rates, with providers winning 85% of line-item claims in 2024. When successful, providers typically receive fees three to four times the typical in-network rate.

APA

Private Equity Stakeholder Project (2025). Profiting on all sides: Private equity and the No Surprises Act. https://pestakeholder.org/news/profiting-on-all-sides-private-equity-and-the-no-surprises-act/

Chicago

Private Equity Stakeholder Project. Profiting on all sides: Private equity and the No Surprises Act. 2025. https://pestakeholder.org/news/profiting-on-all-sides-private-equity-and-the-no-surprises-act/.

Wikipedia

{{cite report |author=Private Equity Stakeholder Project |title=Profiting on all sides: Private equity and the No Surprises Act |date=5 November 2025 |url=https://pestakeholder.org/news/profiting-on-all-sides-private-equity-and-the-no-surprises-act/ |access-date=23 October 2026 |via=Climate Insights Directory}}

BibTeX

@techreport{privateequitystakeholderproject2025profiting, author = {{Private Equity Stakeholder Project}}, title = {{Profiting on all sides: Private equity and the No Surprises Act}}, institution = {Private Equity Stakeholder Project}, year = {2025}, month = nov, url = {https://pestakeholder.org/news/profiting-on-all-sides-private-equity-and-the-no-surprises-act/}, urldate = {2026-10-23}, note = {Indexed by Climate Insights Directory} }