Fifth Circuit vacates NSA ghost-rate and bonus-exclusion rules; Nutex Health to benefit from higher QPA

Nutex Health Inc.

• On Aug 11, 2026, en banc Fifth Circuit in Texas Medical Association v. HHS vacated July 2021 Rule allowing ghost rates and excluding bonus/incentive payments from QPA.
• Court ruled insurers must include bonus and incentive payments and cannot use non-negotiated placeholder rates; vacatur upheld with enforcement discretion for existing QPAs until new rules.
• Ruling cites ghost rates suppressed QPA and led IDR arbitration awards exceeding QPA in 85% of cases.
• Nutex, as a provider negotiating under NSA, expects higher Qualifying Payment Amounts in insurer contracts and IDR disputes.
• Departments directed to promulgate new rules consistent with NSA; interim use of existing QPAs permitted.