Nutex Health Inc. Reports Court Ruling Affecting No Surprises Act QPA

What Happened Nutex Health Inc. filed an 8-K (Item 8.01) on August 13, 2026 reporting a Fifth Circuit en banc decision in Texas Medical Association v. HHS, No. 23-40605, issued August 11, 2026. The court vacated key portions of the July 2021 interim final rule that governed how insurers calculate the Qualifying Payment Amount (QPA) under the No Surprises Act (NSA). The ruling prohibits insurers from including so-called “ghost rates” in QPA calculations and requires inclusion of bonus and incentive payments that the July 2021 rule had instructed insurers to exclude.

Key Details

• Court/case: Fifth Circuit en banc decision in Texas Medical Association v. HHS, No. 23-40605, dated Aug 11, 2026.
• Vacated provisions: those allowing inclusion of non-negotiated “ghost rates” and excluding bonus/incentive or retrospective payments from QPA.
• Court findings: inclusion of ghost rates had artificially suppressed QPAs and the court noted IDR arbitration outcomes exceeded the QPA in ~85% of arbitrations under the old rule.
• Administrative effect: the court upheld vacatur of the July 2021 rule and directed the Departments to exercise enforcement discretion, allowing insurers to continue using their existing QPAs only until new QPAs are calculated under rules consistent with the NSA.

Why It Matters The QPA is central to how insurers and providers (including Nutex) negotiate reimbursement and how unresolved disputes are decided in independent dispute resolution (IDR) arbitration. By barring ghost rates and requiring inclusion of bonus/incentive payments, the decision changes the method for calculating the benchmark QPA, which could affect negotiated rates and arbitration outcomes. The Departments must now adopt new rules, and there is temporary administrative guidance allowing current QPAs to remain in use until those rules are issued, leaving a period of regulatory transition that investors should note.