Highmark sued a pair of medical companies Monday, accusing them of exploiting a consumer protection law to collect nearly $4 million in fraudulent insurance payouts across more than 400 claims.
The lawsuit, filed in federal court in Pittsburgh, claims Philadelphia-area neurodiagnostics company Bromedicon and Texas-based HaloMD coordinated to game the federal No Surprises Act at the expense of Highmark and its members.
The legislation was enacted in 2022 to stop unexpected medical bills for patients who inadvertently receive out-of-network care. This often happens during emergencies or when an out-of-network doctor treats someone at an in-network facility.
Congress created a venue, the independent dispute resolution system, for healthcare providers and insurance companies to solve these issues.
If direct negotiations fail, each side tells an arbitrator what they believe the service is worth. The arbitrator picks between the payment offers and issues a binding decision. Providers win a vast majority of the time.
Highmark says Bromedicon and HaloMD, whose sole service is helping companies win these arbitration cases, is flooding the independent dispute resolution system with bogus claims. The defendants knowingly submitted ineligible expenses and attached false information to their dispute filings, according to the lawsuit.
They also violated a 90-day cooldown on seeking arbitration for a similar service from the same insurer, Highmark says. In some cases, Bromedicon and HaloMD received a determination for certain treatments and initiated a nearly identical dispute the same day.
Cindy Williams, a HaloMD spokeswoman, downplayed the lawsuit as weak.
“Four federal district courts have dismissed similar copy-paste litigation started by the Blue Cross Blue Shield cabal,” Williams said. “Highmark’s lawfare is intended to intimidate doctors out of seeking fair reimbursement for the care they have already provided.”
Bromedicon did not return a request for comment.
Highmark’s allegations reflect a growing sense among insurers they’re being ripped off by providers, who turned what was supposed to be a method for solving niche billing disputes into a cash cow.
The Centers for Medicare and Medicaid Services initially expected providers to submit about 17,000 disputes a year. Since the start of 2022, there have been nearly 5 million cases.
In extreme examples, doctors have used the No Surprises Act to secure six-figure payouts for routine procedures, the New York Times reported in April.
Data from the Centers for Medicare and Medicaid Services shows HaloMD files more disputes than just about any other company. In the second quarter of 2025, the firm accounted for 22% of all submissions through the independent dispute resolution system.
The law has raised healthcare spending by at least $5 billion since it went into effect through administrative costs and higher treatment reimbursements, according to an analysis published in the journal Health Affairs.