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Court Hears Arguments on CMA/CRS Lawsuit against DMHC Balance Billing Regulation
On November 21, a state court in Sacramento heard the CMA's legal challenge to invalidate and enjoin enforcement of the DMHC's regulation defining 'balance billing' as an unfair billing pattern. CMA filed the lawsuit with a coalition of organizations representing other health care providers, including hospitals, ER doctors, anesthesiologists, radiologists, and orthopedists. The CRS is a plaintiff in this litigation.
At the hearing, CMA's attorneys argued that the DMHC lacks the authority to pass or enforce the regulation. The DMHC argued it does have the authority to pass the regulation, and indicated that it will take enforcement actions against providers who 'balance bill' patients. We believe that even if the courts ultimately decide that the DMHC can define balance billing as an unfair billing pattern, the DMHC lacks the authority to take enforcement actions against those providers.
Prior to the hearing, the court issued a tentative ruling finding that the DMHC has the authority to define 'balance billing' as an unfair billing pattern. This ruling is only tentative, pending the issuance of the judge's official ruling, to be made within 90 days of the hearing. If the judge maintains this opinion in his final ruling, the CMA-led coalition plans to appeal and take any other action necessary to bar the DMHC from taking enforcement action based on the regulation.
We will inform you of the final ruling and the planned next steps.
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