{ "attribution": { "source": "legal.exploreworldai.com", "canonical": "https://legal.exploreworldai.com/api/public/v1/judgment-text?id=us:ca2-25-2204-2026-09-17", "cite_as": "NovaCopilot, legal.exploreworldai.com (https://legal.exploreworldai.com/api/public/v1/judgment-text?id=us:ca2-25-2204-2026-09-17)", "license": "https://legal.exploreworldai.com/revision", "version": "legal-2026-10-03", "fingerprint": "ewai:se:ee4348", "proof": "sha256:3ab0a1b84894ca5ac17cdff51cfb4c4f7b2d00c2ee0876bd84b3c539c66ef840", "jurisdiction": "se", "lang": "en", "publisher": "NovaCopilot by ExploreWorld Legal", "terms": "https://legal.exploreworldai.com/om" }, "brand_source": "Source: NovaCopilot", "brand": { "product": "NovaCopilot", "platform": "ExploreWorldAI", "infrastructure": "ExploreWorld Legal", "infrastructure_url": "legal.exploreworldai.com", "legal_entity": "Valkiv Ventures AB", "permanent_url": "https://legal.exploreworldai.com/novacopilot", "source": "Source: NovaCopilot", "powered_by": "Powered by NovaCopilot", "license": "https://legal.exploreworldai.com/licensvillkor", "contact": "stig@valkiv.com" }, "item": { "schema_version": "1.0.0", "id": "us:ca2-25-2204-2026-09-17", "jurisdiction": "us", "lang": "en", "brand_source": "Source: NovaCopilot", "brand": { "product": "NovaCopilot", "platform": "ExploreWorldAI", "infrastructure": "ExploreWorld Legal", "infrastructure_url": "legal.exploreworldai.com", "legal_entity": "Valkiv Ventures AB", "permanent_url": "https://legal.exploreworldai.com/novacopilot", "source": "Source: NovaCopilot", "powered_by": "Powered by NovaCopilot", "license": "https://legal.exploreworldai.com/licensvillkor", "contact": "stig@valkiv.com" }, "sections": [ { "title": "25-2204", "paragraphs": [ "para_2" ] }, { "title": "United States Court of Appeals", "paragraphs": [ "para_4" ] }, { "title": "August Term 2025", "paragraphs": [] }, { "title": "Argued: June 17, 2026", "paragraphs": [] }, { "title": "Decided: September 17, 2026", "paragraphs": [] }, { "title": "No. 25-2204", "paragraphs": [ "para_9", "para_10", "para_11" ] }, { "title": "CIGNA HEALTH AND LIFE INSURANCE COMPANY, CONNECTICUT", "paragraphs": [ "para_13", "para_14" ] }, { "title": "Appeal from the United States District Court", "paragraphs": [ "para_16" ] }, { "title": "No. 25-cv-255", "paragraphs": [ "para_18" ] }, { "title": "2", "paragraphs": [] }, { "title": "Before: LEVAL and PARK, Circuit Judges, and RAKOFF, District Judge.*", "paragraphs": [] }, { "title": "The No Surprises Act (“NSA”) creates an independent dispute", "paragraphs": [ "para_22", "para_23" ] }, { "title": "Advanced Plastic Surgery, LLC (“ECAPS”), won more than $3 million", "paragraphs": [ "para_25", "para_26", "para_27", "para_28", "para_29", "para_30" ] }, { "title": "The text and structure of the NSA make clear that it does not", "paragraphs": [ "para_32", "para_33", "para_34", "para_35", "para_36", "para_37", "para_38", "para_39" ] }, { "title": "ELIZABETH WOLSTEIN (Samuel L. Butt, David J. Goldsmith, on", "paragraphs": [ "para_41", "para_42", "para_43" ] }, { "title": "3", "paragraphs": [] }, { "title": "Law Offices of Michael B. Wolk, P.C., New York, NY, for Plaintiffs-", "paragraphs": [ "para_46", "para_47", "para_48" ] }, { "title": "Defendants-Appellees Cigna Health and Life Insurance Company and", "paragraphs": [ "para_50" ] }, { "title": "PARK, Circuit Judge:", "paragraphs": [] }, { "title": "The No Surprises Act (“NSA”) creates an independent dispute", "paragraphs": [ "para_53", "para_54" ] }, { "title": "Advanced Plastic Surgery, LLC (“ECAPS”), won more than $3 million", "paragraphs": [ "para_56", "para_57", "para_58", "para_59", "para_60", "para_61" ] }, { "title": "The text and structure of the NSA make clear that it does not", "paragraphs": [ "para_63", "para_64", "para_65", "para_66", "para_67", "para_68" ] }, { "title": "4", "paragraphs": [ "para_70", "para_71" ] }, { "title": "I. BACKGROUND", "paragraphs": [] }, { "title": "A. No Surprises Act", "paragraphs": [] }, { "title": "Congress enacted the NSA “to address the issue of patients", "paragraphs": [ "para_75", "para_76" ] }, { "title": "Neurological Surgery Prac. of Long Island, PLLC v. U.S. Dep’t of Health &", "paragraphs": [] }, { "title": "Hum. Servs., 145 F.4th 212, 219 (2d Cir. 2025). Congress was", "paragraphs": [ "para_79", "para_80", "para_81", "para_82", "para_83", "para_84" ] }, { "title": "Under the NSA, an out-of-network provider seeking payment", "paragraphs": [ "para_86", "para_87", "para_88", "para_89", "para_90", "para_91", "para_92" ] }, { "title": "Id. § 1185e(b)(1)(C); see id. § 1185e(a)(1)(C)(iv)(I). If the provider", "paragraphs": [ "para_94", "para_95" ] }, { "title": "5", "paragraphs": [] }, { "title": "Id. § 1185e(c)(1)(A). If the negotiations fail, the provider may", "paragraphs": [ "para_98", "para_99" ] }, { "title": "In the IDR process, the health plan or health insurance issuer", "paragraphs": [ "para_101", "para_102" ] }, { "title": "Id. § 1185e(c)(4)(F), (5)(B). After considering various factors, the", "paragraphs": [ "para_104", "para_105", "para_106", "para_107" ] }, { "title": "The determination “shall not be subject to judicial review, except in a", "paragraphs": [ "para_109" ] }, { "title": "Title 9,” which are the provisions of the Federal Arbitration Act", "paragraphs": [ "para_111" ] }, { "title": "Id. § 1185e(c)(5)(E)(i)(II).1", "paragraphs": [] }, { "title": "The NSA provides that the plan or coverage “shall pay a total", "paragraphs": [ "para_114", "para_115", "para_116" ] }, { "title": "1 The FAA’s grounds for vacatur include “where the award was", "paragraphs": [ "para_118", "para_119", "para_120", "para_121", "para_122", "para_123" ] }, { "title": "6", "paragraphs": [ "para_125", "para_126", "para_127", "para_128" ] }, { "title": "Congress added the NSA to three parts of the U.S. Code, each", "paragraphs": [ "para_130" ] }, { "title": "(1) the Employee Retirement Income Security Act (“ERISA”), which", "paragraphs": [ "para_132", "para_133" ] }, { "title": "2757, 2772–83 (2020); (2) the Internal Revenue Code, which is", "paragraphs": [ "para_135" ] }, { "title": "I.R.C. § 9816; No Surprises Act § 102(c)(1), 134 Stat. at 2784–95; and (3)", "paragraphs": [ "para_137", "para_138", "para_139", "para_140", "para_141", "para_142", "para_143" ] }, { "title": "(c)(5)(C)(i) (DOL); I.R.C. § 9816(a)(2)(B), (c)(2)(A), (c)(4)(A), (c)(5)(C)(i)", "paragraphs": [ "para_145", "para_146" ] }, { "title": "7", "paragraphs": [] }, { "title": "B. Factual Background2", "paragraphs": [] }, { "title": "Defendants Cigna Health and Life Insurance Company and", "paragraphs": [] }, { "title": "Connecticut General Life Insurance Company (together, “Cigna”)", "paragraphs": [ "para_151", "para_152", "para_153", "para_154" ] }, { "title": "Plaintiff ECAPS is a medical practice that offers breast", "paragraphs": [ "para_156", "para_157", "para_158", "para_159" ] }, { "title": "Defendant MPI assembles networks of medical providers and", "paragraphs": [ "para_161", "para_162" ] }, { "title": "ECAPS entered into a contract with MPI that requires ECAPS", "paragraphs": [ "para_164", "para_165", "para_166" ] }, { "title": "ECAPS provided medical services to members of Cigna-", "paragraphs": [ "para_168" ] }, { "title": "Cigna paid ECAPS far less than the 85% Contract Rate. Joint App’x", "paragraphs": [] }, { "title": "2 “On review of a District Court’s decision granting a motion to", "paragraphs": [ "para_171", "para_172" ] }, { "title": "8", "paragraphs": [ "para_174", "para_175", "para_176", "para_177" ] }, { "title": "For its part, Cigna claims that ECAPS engaged in fraudulent", "paragraphs": [ "para_179" ] }, { "title": "ECAPS services. Cigna alleges, for instance, that ECAPS unlawfully", "paragraphs": [ "para_181", "para_182", "para_183" ] }, { "title": "C. Procedural History", "paragraphs": [] }, { "title": "Cigna sued ECAPS under ERISA, the Declaratory Judgment", "paragraphs": [] }, { "title": "Act, and Connecticut statutory law and asserted claims for common-", "paragraphs": [ "para_187", "para_188", "para_189" ] }, { "title": "ECAPS seeks a judgment under the Declaratory Judgment Act that (1)", "paragraphs": [] }, { "title": "Cigna violated its “obligation under the NSA to pay IDR", "paragraphs": [ "para_192", "para_193", "para_194" ] }, { "title": "Cigna . . . to ECAPS”; and (3) “ECAPS is entitled to all necessary and", "paragraphs": [] }, { "title": "3 The second plaintiff in the ECAPS action is Marcella Livolsi, a", "paragraphs": [ "para_197", "para_198", "para_199" ] }, { "title": "9", "paragraphs": [ "para_201", "para_202" ] }, { "title": "ECAPS action were designated as related, and each defendant moved", "paragraphs": [ "para_204" ] }, { "title": "The district court granted Cigna’s motion to dismiss ECAPS’s", "paragraphs": [ "para_206" ] }, { "title": "NSA does not contain an express or implied private right of action to", "paragraphs": [ "para_208", "para_209", "para_210", "para_211" ] }, { "title": "II. DISCUSSION", "paragraphs": [] }, { "title": "A. Legal Framework", "paragraphs": [] }, { "title": "We review de novo “the district court’s grant of defendants’", "paragraphs": [ "para_215" ] }, { "title": "Union Loc. 456, 781 F.3d 25, 26 (2d Cir. 2015). “A decision that a", "paragraphs": [ "para_217", "para_218", "para_219" ] }, { "title": "4 ECAPS’s complaint also named MPI as a defendant, and MPI", "paragraphs": [ "para_221" ] }, { "title": "MPI’s and Cigna’s dismissal motions. MPI, which is represented by", "paragraphs": [] }, { "title": "Phelps Dunbar LLP, did not file a brief or otherwise participate in this", "paragraphs": [ "para_224" ] }, { "title": "10", "paragraphs": [ "para_226", "para_227" ] }, { "title": "608, 613 (2026). “When Congress creates a private right of action, it", "paragraphs": [ "para_229", "para_230", "para_231", "para_232", "para_233", "para_234", "para_235" ] }, { "title": "The Supreme Court thus has “strictly curtailed the authority of", "paragraphs": [ "para_237", "para_238" ] }, { "title": "532 U.S. 275 (2001), the Court required “that a review of the text and", "paragraphs": [ "para_240", "para_241", "para_242", "para_243" ] }, { "title": "Following that approach, we first consider the statute’s text and", "paragraphs": [ "para_245", "para_246", "para_247" ] }, { "title": "120 F.4th 1107, 1112 (2d Cir. 2024) (cleaned up). “Next, we consider", "paragraphs": [ "para_249", "para_250", "para_251" ] }, { "title": "11", "paragraphs": [ "para_253", "para_254", "para_255", "para_256" ] }, { "title": "B. Analysis", "paragraphs": [] }, { "title": "ECAPS contends that the NSA contains an implied private", "paragraphs": [ "para_259", "para_260" ] }, { "title": "NSA’s text and structure do not “yield a clear manifestation of", "paragraphs": [ "para_262", "para_263", "para_264", "para_265", "para_266" ] }, { "title": "1. Text", "paragraphs": [] }, { "title": "The NSA lacks an express private right of action to enforce IDR", "paragraphs": [ "para_269" ] }, { "title": "5 Whether the NSA implies a private cause of action to enforce IDR", "paragraphs": [ "para_271", "para_272" ] }, { "title": "229 (D. Conn. 2025) (concluding that “the NSA creates a private cause of", "paragraphs": [ "para_274" ] }, { "title": "824 F. Supp. 3d 217, 224 (D. Conn. 2026) (“The Court . . . concludes, as have", "paragraphs": [ "para_276", "para_277" ] }, { "title": "12", "paragraphs": [ "para_279", "para_280", "para_281", "para_282", "para_283", "para_284" ] }, { "title": "Congress has incorporated the FAA’s provision for confirming", "paragraphs": [ "para_286", "para_287", "para_288", "para_289", "para_290", "para_291" ] }, { "title": "Guardian Flight, 140 F.4th at 276–77.6", "paragraphs": [] }, { "title": "To be sure, the NSA does use rights-creating language, but that", "paragraphs": [ "para_294", "para_295", "para_296", "para_297", "para_298", "para_299" ] }, { "title": "6 ECAPS contends that Congress did not need to incorporate the", "paragraphs": [] }, { "title": "FAA’s confirmation provision because that provision applies to awards", "paragraphs": [ "para_302", "para_303", "para_304", "para_305" ] }, { "title": "13", "paragraphs": [ "para_307", "para_308", "para_309", "para_310" ] }, { "title": "But it is not enough that Congress uses rights-creating", "paragraphs": [ "para_312", "para_313", "para_314", "para_315", "para_316" ] }, { "title": "Univ. v. Doe, 536 U.S. 273, 284 (2002) (quoting Sandoval, 532 U.S. at", "paragraphs": [] }, { "title": "286). The NSA does not manifest an intent to create a private", "paragraphs": [ "para_319" ] }, { "title": "2. Statutory Scheme", "paragraphs": [] }, { "title": "Congress created in the NSA a comprehensive regulatory", "paragraphs": [ "para_322", "para_323" ] }, { "title": "HHS—with establishing the IDR process, including the certification", "paragraphs": [ "para_325", "para_326", "para_327", "para_328", "para_329" ] }, { "title": "On the back end, Congress designed an interlocking federal", "paragraphs": [ "para_331" ] }, { "title": "Treasury have the authority to address NSA violations by private", "paragraphs": [] }, { "title": "14", "paragraphs": [ "para_334", "para_335", "para_336", "para_337", "para_338", "para_339", "para_340" ] }, { "title": "U.S.C. §§ 1132(a)(5), 1003(a).7 So DOL may file civil lawsuits against", "paragraphs": [ "para_342", "para_343", "para_344", "para_345", "para_346" ] }, { "title": "9834. 8 Treasury thus may impose a tax when non-governmental", "paragraphs": [ "para_348" ] }, { "title": "Second, HHS has the authority to respond to NSA violations by", "paragraphs": [ "para_350" ] }, { "title": "Service Act provides that “any non-Federal governmental plan that is", "paragraphs": [] }, { "title": "7 Subchapter I of ERISA does not apply to any “governmental plan,”", "paragraphs": [ "para_353", "para_354", "para_355" ] }, { "title": "8 A “group health plan” under the Internal Revenue Code includes", "paragraphs": [ "para_357", "para_358" ] }, { "title": "9832(a). The “term ‘employer’ does not include a Federal or other", "paragraphs": [ "para_360" ] }, { "title": "15", "paragraphs": [ "para_362" ] }, { "title": "Subchapter XXV, which also houses the NSA, “is subject to a civil", "paragraphs": [ "para_364" ] }, { "title": "So HHS may impose civil money penalties on state and local", "paragraphs": [ "para_366" ] }, { "title": "See E. Coast Advanced Plastic Surgery, 2025 WL 2371537, at *17", "paragraphs": [] }, { "title": "(observing that the IDR process is “subject to oversight and", "paragraphs": [ "para_369" ] }, { "title": "Finally, the Public Health Service Act permits states to enforce", "paragraphs": [ "para_371", "para_372", "para_373", "para_374", "para_375" ] }, { "title": "Congress thus contemplated state enforcement of the NSA, codified", "paragraphs": [ "para_377" ] }, { "title": "Taken together, these provisions reflect “Congress’s policy", "paragraphs": [ "para_379", "para_380", "para_381" ] }, { "title": "9 ECAPS contends that HHS lacks jurisdiction over private", "paragraphs": [ "para_383", "para_384" ] }, { "title": "HHS’s authority to enforce the NSA against non-federal governmental", "paragraphs": [ "para_386", "para_387" ] }, { "title": "16", "paragraphs": [ "para_389" ] }, { "title": "U.S. at 290; see FS Credit, 608 U.S. at 616–17 (explaining that the", "paragraphs": [] }, { "title": "Securities and Exchange Commission’s “responsibility for ensuring", "paragraphs": [ "para_392", "para_393", "para_394", "para_395", "para_396" ] }, { "title": "Here, Congress expressly provided for DOL and Treasury to enforce", "paragraphs": [] }, { "title": "IDR awards entered against private employer-sponsored group", "paragraphs": [ "para_399", "para_400", "para_401", "para_402", "para_403" ] }, { "title": "3. ECAPS’s Other Arguments", "paragraphs": [] }, { "title": "ECAPS raises a host of counterarguments, but none is", "paragraphs": [ "para_406", "para_407", "para_408" ] }, { "title": "But Congress had no reason to do so because ERISA and the Internal", "paragraphs": [] }, { "title": "Revenue Code, each of which the NSA amends, already authorize", "paragraphs": [ "para_411" ] }, { "title": "(declining to imply a private right of action in a statute that", "paragraphs": [ "para_413", "para_414" ] }, { "title": "17", "paragraphs": [ "para_416" ] }, { "title": "Carrier Access Act, supports the conclusion that the Act does not", "paragraphs": [ "para_418" ] }, { "title": "Second, ECAPS argues that DOL’s efforts to enforce the IDR", "paragraphs": [ "para_420" ] }, { "title": "Congress authorizes agency enforcement, not how actively the", "paragraphs": [ "para_422", "para_423", "para_424", "para_425" ] }, { "title": "Third, ECAPS highlights that the Secretary of the Treasury may", "paragraphs": [ "para_427", "para_428", "para_429", "para_430", "para_431" ] }, { "title": "10 Congress enacted ERISA’s agency-enforcement provisions in", "paragraphs": [ "para_433" ] }, { "title": "93-406, § 502(a), 88 Stat. 829, 891. It added the tax-penalty provisions to", "paragraphs": [ "para_435", "para_436" ] }, { "title": "2084–87. These provisions long predate the NSA, which was enacted in", "paragraphs": [ "para_438" ] }, { "title": "11 Nor does ECAPS identify any authority stating that agency", "paragraphs": [ "para_440", "para_441" ] }, { "title": "18", "paragraphs": [] }, { "title": "Fourth, ECAPS argues that “Congress’s vesting of IDR", "paragraphs": [ "para_444", "para_445" ] }, { "title": "33–34. But this begs the question because the provision making the", "paragraphs": [] }, { "title": "IDR determination “binding upon the parties involved” says nothing", "paragraphs": [ "para_448" ] }, { "title": "Fifth, ECAPS’s invocation of cases involving the Tucker Act", "paragraphs": [ "para_450", "para_451", "para_452" ] }, { "title": "Cmty. Health Options v. United States, 590 U.S. 296, 322 (2020). If a", "paragraphs": [ "para_454" ] }, { "title": "Federal Government for the damage sustained,” it generally suffices", "paragraphs": [ "para_456", "para_457", "para_458", "para_459", "para_460", "para_461", "para_462" ] }, { "title": "12 ECAPS cites cases holding that a party may seek judicial", "paragraphs": [ "para_464", "para_465", "para_466", "para_467", "para_468" ] }, { "title": "And several involve arbitration agreements, not a dispute-resolution", "paragraphs": [ "para_470" ] }, { "title": "19", "paragraphs": [] }, { "title": "Tucker Act” does not control here, id. at 324 (quotation marks", "paragraphs": [ "para_473", "para_474", "para_475", "para_476", "para_477" ] }, { "title": "Gonzaga, 536 U.S. at 284 (internal citation omitted). That", "paragraphs": [ "para_479", "para_480" ] }, { "title": "Sixth, ECAPS contends that declining to imply a private right", "paragraphs": [ "para_482", "para_483", "para_484", "para_485" ] }, { "title": "Appellants’ Br. at 46. We disagree. As explained above, Congress", "paragraphs": [ "para_487" ] }, { "title": "NSA. A health plan or insurer may well prefer to seek vacatur of an", "paragraphs": [ "para_489", "para_490", "para_491", "para_492" ] }, { "title": "Finally, ECAPS argues that denying a private enforcement", "paragraphs": [ "para_494", "para_495", "para_496", "para_497" ] }, { "title": "20", "paragraphs": [ "para_499", "para_500", "para_501" ] }, { "title": "In short, ECAPS has not shown that “Congress ‘affirmatively", "paragraphs": [ "para_503" ] }, { "title": "We thus conclude that the NSA does not create an implied private", "paragraphs": [ "para_505", "para_506" ] }, { "title": "C. Declaratory Judgment Act", "paragraphs": [] }, { "title": "ECAPS contends that even if the NSA does not imply a private", "paragraphs": [ "para_509" ] }, { "title": "13 Cigna contends that the NSA “bars providers from bringing", "paragraphs": [ "para_511", "para_512", "para_513", "para_514" ] }, { "title": "FAA].” 29 U.S.C. § 1185e(c)(5)(E)(i). Cigna maintains that the term", "paragraphs": [ "para_516", "para_517" ] }, { "title": "Guardian Flight, 140 F.4th at 275–76 (adopting this interpretation). We", "paragraphs": [ "para_519", "para_520", "para_521", "para_522" ] }, { "title": "21", "paragraphs": [ "para_524", "para_525" ] }, { "title": "As the district court correctly explained, the Declaratory", "paragraphs": [ "para_527" ] }, { "title": "Coast Advanced Plastic Surgery, 2025 WL 2371537, at *18 (quoting", "paragraphs": [] }, { "title": "Chevron Corp. v. Naranjo, 667 F.3d 232, 244 (2d Cir. 2012)). A “court", "paragraphs": [ "para_530", "para_531" ] }, { "title": "Asbestos Litig., 14 F.3d 726, 731 (2d Cir. 1993). Without an implied", "paragraphs": [ "para_533", "para_534", "para_535" ] }, { "title": "III. CONCLUSION", "paragraphs": [] }, { "title": "We have considered ECAPS’s remaining arguments and find", "paragraphs": [ "para_538", "para_539" ] } ], "paragraphs": [ { "text": "25-2204", "paragraph_id": "para_1" }, { "text": "E. Coast Advanced Plastic Surgery, LLC v. Cigna Health & Life Ins. Co.", "paragraph_id": "para_2" }, { "text": "United States Court of Appeals", "paragraph_id": "para_3" }, { "text": "for the Second Circuit", "paragraph_id": "para_4" }, { "text": "August Term 2025", "paragraph_id": "para_5" }, { "text": "Argued: June 17, 2026", "paragraph_id": "para_6" }, { "text": "Decided: September 17, 2026", "paragraph_id": "para_7" }, { "text": "No. 25-2204", "paragraph_id": "para_8" }, { "text": "EAST COAST ADVANCED PLASTIC SURGERY, LLC, MARCELLA LIVOLSI,", "paragraph_id": "para_9" }, { "text": "Plaintiffs-Appellants,", "paragraph_id": "para_10" }, { "text": "v.", "paragraph_id": "para_11" }, { "text": "CIGNA HEALTH AND LIFE INSURANCE COMPANY, CONNECTICUT", "paragraph_id": "para_12" }, { "text": "GENERAL LIFE INSURANCE COMPANY, MULTIPLAN, INC.,", "paragraph_id": "para_13" }, { "text": "Defendants-Appellees.", "paragraph_id": "para_14" }, { "text": "Appeal from the United States District Court", "paragraph_id": "para_15" }, { "text": "for the Southern District of New York", "paragraph_id": "para_16" }, { "text": "No. 25-cv-255", "paragraph_id": "para_17" }, { "text": "Paul A. Engelmayer, Judge.", "paragraph_id": "para_18" }, { "text": "2", "paragraph_id": "para_19" }, { "text": "Before: LEVAL and PARK, Circuit Judges, and RAKOFF, District Judge.*", "paragraph_id": "para_20" }, { "text": "The No Surprises Act (“NSA”) creates an independent dispute", "paragraph_id": "para_21" }, { "text": "resolution (“IDR”) process for payment disputes between health", "paragraph_id": "para_22" }, { "text": "plans and out-of-network providers. One such provider, East Coast", "paragraph_id": "para_23" }, { "text": "Advanced Plastic Surgery, LLC (“ECAPS”), won more than $3 million", "paragraph_id": "para_24" }, { "text": "in IDR awards against health-plan administrator Cigna, which Cigna", "paragraph_id": "para_25" }, { "text": "did not pay. ECAPS brought a federal lawsuit seeking a declaration", "paragraph_id": "para_26" }, { "text": "that Cigna owes it the award amounts and violated the NSA by failing", "paragraph_id": "para_27" }, { "text": "to pay. The district court (Engelmayer, J.) dismissed ECAPS’s", "paragraph_id": "para_28" }, { "text": "complaint for failure to state a claim, concluding that the NSA does", "paragraph_id": "para_29" }, { "text": "not contain an implied private cause of action.", "paragraph_id": "para_30" }, { "text": "The text and structure of the NSA make clear that it does not", "paragraph_id": "para_31" }, { "text": "provide a private right of action to enforce payment awards obtained", "paragraph_id": "para_32" }, { "text": "through the NSA’s IDR process. Although the NSA gives providers", "paragraph_id": "para_33" }, { "text": "a right to payment from health plans for certain services, it delegates", "paragraph_id": "para_34" }, { "text": "enforcement authority to multiple federal agencies and to states.", "paragraph_id": "para_35" }, { "text": "This statutory scheme reflects Congress’s intent that the NSA,", "paragraph_id": "para_36" }, { "text": "including payment of IDR awards, be enforced through", "paragraph_id": "para_37" }, { "text": "administrative action rather than private litigation. We thus", "paragraph_id": "para_38" }, { "text": "AFFIRM the judgment of the district court.", "paragraph_id": "para_39" }, { "text": "ELIZABETH WOLSTEIN (Samuel L. Butt, David J. Goldsmith, on", "paragraph_id": "para_40" }, { "text": "the brief), Schlam Stone & Dolan LLP, New York, NY; Michael B. Wolk,", "paragraph_id": "para_41" }, { "text": "* Judge Jed S. Rakoff of the United States District Court for the", "paragraph_id": "para_42" }, { "text": "Southern District of New York, sitting by designation.", "paragraph_id": "para_43" }, { "text": "3", "paragraph_id": "para_44" }, { "text": "Law Offices of Michael B. Wolk, P.C., New York, NY, for Plaintiffs-", "paragraph_id": "para_45" }, { "text": "Appellants.", "paragraph_id": "para_46" }, { "text": "RICHARD W. NICHOLSON, JR. (Joshua B. Simon, Warren Haskel,", "paragraph_id": "para_47" }, { "text": "on the brief), McDermott Will & Schulte LLP, New York, NY, for", "paragraph_id": "para_48" }, { "text": "Defendants-Appellees Cigna Health and Life Insurance Company and", "paragraph_id": "para_49" }, { "text": "Connecticut General Life Insurance Company.", "paragraph_id": "para_50" }, { "text": "PARK, Circuit Judge:", "paragraph_id": "para_51" }, { "text": "The No Surprises Act (“NSA”) creates an independent dispute", "paragraph_id": "para_52" }, { "text": "resolution (“IDR”) process for payment disputes between health", "paragraph_id": "para_53" }, { "text": "plans and out-of-network providers. One such provider, East Coast", "paragraph_id": "para_54" }, { "text": "Advanced Plastic Surgery, LLC (“ECAPS”), won more than $3 million", "paragraph_id": "para_55" }, { "text": "in IDR awards against health-plan administrator Cigna, which Cigna", "paragraph_id": "para_56" }, { "text": "did not pay. ECAPS brought a federal lawsuit seeking a declaration", "paragraph_id": "para_57" }, { "text": "that Cigna owes it the award amounts and violated the NSA by failing", "paragraph_id": "para_58" }, { "text": "to pay. The district court (Engelmayer, J.) dismissed ECAPS’s", "paragraph_id": "para_59" }, { "text": "complaint for failure to state a claim, concluding that the NSA does", "paragraph_id": "para_60" }, { "text": "not contain an implied private cause of action.", "paragraph_id": "para_61" }, { "text": "The text and structure of the NSA make clear that it does not", "paragraph_id": "para_62" }, { "text": "provide a private right of action to enforce payment awards obtained", "paragraph_id": "para_63" }, { "text": "through the NSA’s IDR process. Although the NSA gives providers", "paragraph_id": "para_64" }, { "text": "a right to payment from health plans for certain services, it delegates", "paragraph_id": "para_65" }, { "text": "enforcement authority to multiple federal agencies and to states.", "paragraph_id": "para_66" }, { "text": "This statutory scheme reflects Congress’s intent that the NSA,", "paragraph_id": "para_67" }, { "text": "including payment of IDR awards, be enforced through", "paragraph_id": "para_68" }, { "text": "4", "paragraph_id": "para_69" }, { "text": "administrative action rather than private litigation. We thus affirm", "paragraph_id": "para_70" }, { "text": "the judgment of the district court.", "paragraph_id": "para_71" }, { "text": "I. BACKGROUND", "paragraph_id": "para_72" }, { "text": "A. No Surprises Act", "paragraph_id": "para_73" }, { "text": "Congress enacted the NSA “to address the issue of patients", "paragraph_id": "para_74" }, { "text": "facing unexpected—and often exceedingly large—medical bills after", "paragraph_id": "para_75" }, { "text": "they received treatment from out-of-network providers.”", "paragraph_id": "para_76" }, { "text": "Neurological Surgery Prac. of Long Island, PLLC v. U.S. Dep’t of Health &", "paragraph_id": "para_77" }, { "text": "Hum. Servs., 145 F.4th 212, 219 (2d Cir. 2025). Congress was", "paragraph_id": "para_78" }, { "text": "responding to “complaints that patients, and their insurers, were", "paragraph_id": "para_79" }, { "text": "susceptible to receiving ‘surprise’ bills from providers in", "paragraph_id": "para_80" }, { "text": "circumstances, like emergency room visits or anesthesia", "paragraph_id": "para_81" }, { "text": "administration, where they had no realistic choice of lower-cost in-", "paragraph_id": "para_82" }, { "text": "network providers.” Tex. Med. Ass’n v. U.S. Dep’t of Health & Hum.", "paragraph_id": "para_83" }, { "text": "Servs., 110 F.4th 762, 768 (5th Cir. 2024).", "paragraph_id": "para_84" }, { "text": "Under the NSA, an out-of-network provider seeking payment", "paragraph_id": "para_85" }, { "text": "for certain “items or services” “furnished to” a patient must", "paragraph_id": "para_86" }, { "text": "“transmit[]” a “bill for such items or services” to the patient’s “group", "paragraph_id": "para_87" }, { "text": "health plan or health insurance issuer offering group health insurance", "paragraph_id": "para_88" }, { "text": "coverage,” rather than billing the patient directly. 29 U.S.C.", "paragraph_id": "para_89" }, { "text": "§ 1185e(b)(1); see id. § 1185e(a)(1)(C)(iv)(I). The “plan or", "paragraph_id": "para_90" }, { "text": "coverage . . . shall send to the provider an initial payment or notice of", "paragraph_id": "para_91" }, { "text": "denial of payment” within 30 days of the transmission.", "paragraph_id": "para_92" }, { "text": "Id. § 1185e(b)(1)(C); see id. § 1185e(a)(1)(C)(iv)(I). If the provider", "paragraph_id": "para_93" }, { "text": "disagrees with the payment decision, it may “initiate open", "paragraph_id": "para_94" }, { "text": "negotiations” to try to reach agreement on the payment amount.", "paragraph_id": "para_95" }, { "text": "5", "paragraph_id": "para_96" }, { "text": "Id. § 1185e(c)(1)(A). If the negotiations fail, the provider may", "paragraph_id": "para_97" }, { "text": "“initiate the independent dispute resolution process.”", "paragraph_id": "para_98" }, { "text": "Id. § 1185e(c)(1)(B).", "paragraph_id": "para_99" }, { "text": "In the IDR process, the health plan or health insurance issuer", "paragraph_id": "para_100" }, { "text": "and the provider each submit “an offer for a payment amount” to a", "paragraph_id": "para_101" }, { "text": "third-party arbitrator known as a “certified IDR entity.”", "paragraph_id": "para_102" }, { "text": "Id. § 1185e(c)(4)(F), (5)(B). After considering various factors, the", "paragraph_id": "para_103" }, { "text": "certified IDR entity “select[s] one of the offers submitted . . . to be the", "paragraph_id": "para_104" }, { "text": "amount of payment” and notifies the parties “of the offer selected.”", "paragraph_id": "para_105" }, { "text": "Id. § 1185e(c)(5)(A). The IDR entity’s payment “determination . . .", "paragraph_id": "para_106" }, { "text": "shall be binding upon the parties involved.” Id. § 1185e(c)(5)(E)(i).", "paragraph_id": "para_107" }, { "text": "The determination “shall not be subject to judicial review, except in a", "paragraph_id": "para_108" }, { "text": "case described in any of paragraphs (1) through (4) of section 10(a) of", "paragraph_id": "para_109" }, { "text": "Title 9,” which are the provisions of the Federal Arbitration Act", "paragraph_id": "para_110" }, { "text": "(“FAA”) setting forth the grounds for vacating an arbitration award.", "paragraph_id": "para_111" }, { "text": "Id. § 1185e(c)(5)(E)(i)(II).1", "paragraph_id": "para_112" }, { "text": "The NSA provides that the plan or coverage “shall pay a total", "paragraph_id": "para_113" }, { "text": "plan or coverage payment directly . . . to” the out-of-network provider", "paragraph_id": "para_114" }, { "text": "based on a statutory formula. Id. § 1185e(b)(1)(D); see id.", "paragraph_id": "para_115" }, { "text": "§ 1185e(a)(1)(C)(iv)(II). If the amount owed is determined through", "paragraph_id": "para_116" }, { "text": "1 The FAA’s grounds for vacatur include “where the award was", "paragraph_id": "para_117" }, { "text": "procured by corruption, fraud, or undue means”; “where there was evident", "paragraph_id": "para_118" }, { "text": "partiality or corruption in the arbitrators”; “where the arbitrators were", "paragraph_id": "para_119" }, { "text": "guilty of . . . misbehavior by which the rights of any party have been", "paragraph_id": "para_120" }, { "text": "prejudiced”; and “where the arbitrators exceeded their powers, or so", "paragraph_id": "para_121" }, { "text": "imperfectly executed them that a mutual, final, and definite award upon", "paragraph_id": "para_122" }, { "text": "the subject matter submitted was not made.” 9 U.S.C. § 10(a).", "paragraph_id": "para_123" }, { "text": "6", "paragraph_id": "para_124" }, { "text": "the IDR process or open negotiations, the “total plan or coverage", "paragraph_id": "para_125" }, { "text": "payment . . . shall be made directly to the . . . provider . . . not later", "paragraph_id": "para_126" }, { "text": "than 30 days after the date on which such determination is made.”", "paragraph_id": "para_127" }, { "text": "Id. § 1185e(c)(6).", "paragraph_id": "para_128" }, { "text": "Congress added the NSA to three parts of the U.S. Code, each", "paragraph_id": "para_129" }, { "text": "of which is enforced by a separate federal agency. The NSA amends", "paragraph_id": "para_130" }, { "text": "(1) the Employee Retirement Income Security Act (“ERISA”), which", "paragraph_id": "para_131" }, { "text": "is administered by the Department of Labor (“DOL”), see id. § 1185e;", "paragraph_id": "para_132" }, { "text": "No Surprises Act, Pub. L. No. 116-260, div. BB, § 102(b)(1), 134 Stat.", "paragraph_id": "para_133" }, { "text": "2757, 2772–83 (2020); (2) the Internal Revenue Code, which is", "paragraph_id": "para_134" }, { "text": "implemented by the Department of the Treasury (“Treasury”), see", "paragraph_id": "para_135" }, { "text": "I.R.C. § 9816; No Surprises Act § 102(c)(1), 134 Stat. at 2784–95; and (3)", "paragraph_id": "para_136" }, { "text": "the Public Health Service Act, which is enforced by the Department", "paragraph_id": "para_137" }, { "text": "of Health and Human Services (“HHS”), see 42 U.S.C. § 300gg-111; No", "paragraph_id": "para_138" }, { "text": "Surprises Act § 102(a)(1), 134 Stat. at 2758–70.", "paragraph_id": "para_139" }, { "text": "Reflecting its triple codification, the NSA tasks DOL, Treasury,", "paragraph_id": "para_140" }, { "text": "and HHS with establishing the IDR process, creating a process to", "paragraph_id": "para_141" }, { "text": "certify IDR entities, and setting the methodology for determining IDR", "paragraph_id": "para_142" }, { "text": "award amounts. See 29 U.S.C. § 1185e(a)(2), (c)(2)(A), (c)(4)(A),", "paragraph_id": "para_143" }, { "text": "(c)(5)(C)(i) (DOL); I.R.C. § 9816(a)(2)(B), (c)(2)(A), (c)(4)(A), (c)(5)(C)(i)", "paragraph_id": "para_144" }, { "text": "(Treasury); 42 U.S.C. § 300gg-111(a)(2)(B), (c)(2)(A), (c)(4)(A),", "paragraph_id": "para_145" }, { "text": "(c)(5)(C)(i) (HHS).", "paragraph_id": "para_146" }, { "text": "7", "paragraph_id": "para_147" }, { "text": "B. Factual Background2", "paragraph_id": "para_148" }, { "text": "Defendants Cigna Health and Life Insurance Company and", "paragraph_id": "para_149" }, { "text": "Connecticut General Life Insurance Company (together, “Cigna”)", "paragraph_id": "para_150" }, { "text": "administer private employer-sponsored group health plans, which", "paragraph_id": "para_151" }, { "text": "provide healthcare coverage to employees. As relevant here, Cigna", "paragraph_id": "para_152" }, { "text": "sets the amount of plan funds the plan will pay to reimburse", "paragraph_id": "para_153" }, { "text": "providers for covered services provided to plan members.", "paragraph_id": "para_154" }, { "text": "Plaintiff ECAPS is a medical practice that offers breast", "paragraph_id": "para_155" }, { "text": "reconstruction surgery to breast cancer patients who have undergone", "paragraph_id": "para_156" }, { "text": "mastectomies. ECAPS is an out-of-network provider that has no", "paragraph_id": "para_157" }, { "text": "contract with Cigna or any health plan to provide medical services to", "paragraph_id": "para_158" }, { "text": "plan subscribers at in-network rates.", "paragraph_id": "para_159" }, { "text": "Defendant MPI assembles networks of medical providers and", "paragraph_id": "para_160" }, { "text": "sells access to those networks to administrators or insurers of group", "paragraph_id": "para_161" }, { "text": "health plans, including Cigna.", "paragraph_id": "para_162" }, { "text": "ECAPS entered into a contract with MPI that requires ECAPS", "paragraph_id": "para_163" }, { "text": "to provide medical services to individuals covered by Cigna-", "paragraph_id": "para_164" }, { "text": "administered plans. In exchange, Cigna is obligated to pay ECAPS", "paragraph_id": "para_165" }, { "text": "a “Contract Rate,” defined as 85% of ECAPS’s billed charges.", "paragraph_id": "para_166" }, { "text": "ECAPS provided medical services to members of Cigna-", "paragraph_id": "para_167" }, { "text": "administered plans but, in the “overwhelming majority” of cases,", "paragraph_id": "para_168" }, { "text": "Cigna paid ECAPS far less than the 85% Contract Rate. Joint App’x", "paragraph_id": "para_169" }, { "text": "2 “On review of a District Court’s decision granting a motion to", "paragraph_id": "para_170" }, { "text": "dismiss, we take as true the facts set forth in the complaint.” Nat’l Credit", "paragraph_id": "para_171" }, { "text": "Union Admin. Bd. v. U.S. Bank Nat’l Ass’n, 898 F.3d 243, 245 n.1 (2d Cir. 2018).", "paragraph_id": "para_172" }, { "text": "8", "paragraph_id": "para_173" }, { "text": "at 42. ECAPS invoked the IDR process and obtained IDR awards", "paragraph_id": "para_174" }, { "text": "against Cigna in amounts exceeding $3 million. Although the NSA", "paragraph_id": "para_175" }, { "text": "requires payment of IDR awards within 30 days, Cigna has made no", "paragraph_id": "para_176" }, { "text": "payments to ECAPS.", "paragraph_id": "para_177" }, { "text": "For its part, Cigna claims that ECAPS engaged in fraudulent", "paragraph_id": "para_178" }, { "text": "billing practices, causing Cigna to overpay by $8.5 million for certain", "paragraph_id": "para_179" }, { "text": "ECAPS services. Cigna alleges, for instance, that ECAPS unlawfully", "paragraph_id": "para_180" }, { "text": "billed it for (1) claims for services ECAPS had not sufficiently", "paragraph_id": "para_181" }, { "text": "documented, (2) duplicate claims for the same service, and (3) claims", "paragraph_id": "para_182" }, { "text": "for medically unnecessary services.", "paragraph_id": "para_183" }, { "text": "C. Procedural History", "paragraph_id": "para_184" }, { "text": "Cigna sued ECAPS under ERISA, the Declaratory Judgment", "paragraph_id": "para_185" }, { "text": "Act, and Connecticut statutory law and asserted claims for common-", "paragraph_id": "para_186" }, { "text": "law fraud, negligent misrepresentation, unjust enrichment, and", "paragraph_id": "para_187" }, { "text": "conversion. ECAPS then sued Cigna, requesting, among other", "paragraph_id": "para_188" }, { "text": "things, declaratory relief for Cigna’s alleged violations of the NSA.3", "paragraph_id": "para_189" }, { "text": "ECAPS seeks a judgment under the Declaratory Judgment Act that (1)", "paragraph_id": "para_190" }, { "text": "Cigna violated its “obligation under the NSA to pay IDR", "paragraph_id": "para_191" }, { "text": "determinations obtained by ECAPS within 30 days, by failing to pay", "paragraph_id": "para_192" }, { "text": "any portion of those determinations”; (2) Cigna “owes ECAPS the", "paragraph_id": "para_193" }, { "text": "amounts determined through the IDR process to be owed by", "paragraph_id": "para_194" }, { "text": "Cigna . . . to ECAPS”; and (3) “ECAPS is entitled to all necessary and", "paragraph_id": "para_195" }, { "text": "3 The second plaintiff in the ECAPS action is Marcella Livolsi, a", "paragraph_id": "para_196" }, { "text": "participant in a Cigna-administered plan who received out-of-network", "paragraph_id": "para_197" }, { "text": "services from ECAPS. ECAPS and Livolsi are represented by the same", "paragraph_id": "para_198" }, { "text": "counsel on appeal, and we refer to both appellants as ECAPS.", "paragraph_id": "para_199" }, { "text": "9", "paragraph_id": "para_200" }, { "text": "proper relief . . . , including but not limited to equitable relief and", "paragraph_id": "para_201" }, { "text": "monetary relief.” Joint App’x at 65. The Cigna action and the", "paragraph_id": "para_202" }, { "text": "ECAPS action were designated as related, and each defendant moved", "paragraph_id": "para_203" }, { "text": "to dismiss.", "paragraph_id": "para_204" }, { "text": "The district court granted Cigna’s motion to dismiss ECAPS’s", "paragraph_id": "para_205" }, { "text": "complaint for failure to state a claim.4 The court concluded that the", "paragraph_id": "para_206" }, { "text": "NSA does not contain an express or implied private right of action to", "paragraph_id": "para_207" }, { "text": "enforce IDR awards and that the Declaratory Judgment Act “does not", "paragraph_id": "para_208" }, { "text": "provide an independent cause of action.” E. Coast Advanced Plastic", "paragraph_id": "para_209" }, { "text": "Surgery, LLC v. Cigna Health & Life Ins. Co., Nos. 25 Civ. 255, 25 Civ.", "paragraph_id": "para_210" }, { "text": "1686, 2025 WL 2371537, at *17–18 (S.D.N.Y. Aug. 14, 2025).", "paragraph_id": "para_211" }, { "text": "II. DISCUSSION", "paragraph_id": "para_212" }, { "text": "A. Legal Framework", "paragraph_id": "para_213" }, { "text": "We review de novo “the district court’s grant of defendants’", "paragraph_id": "para_214" }, { "text": "motions to dismiss” for failure to state a claim. Ricci v. Teamsters", "paragraph_id": "para_215" }, { "text": "Union Loc. 456, 781 F.3d 25, 26 (2d Cir. 2015). “A decision that a", "paragraph_id": "para_216" }, { "text": "statute does not authorize a private right of action is . . . a purely legal", "paragraph_id": "para_217" }, { "text": "ruling, which we review de novo.” Vengalattore v. Cornell Univ., 36", "paragraph_id": "para_218" }, { "text": "F.4th 87, 101 (2d Cir. 2022).", "paragraph_id": "para_219" }, { "text": "4 ECAPS’s complaint also named MPI as a defendant, and MPI", "paragraph_id": "para_220" }, { "text": "separately moved to dismiss. The district court simultaneously granted", "paragraph_id": "para_221" }, { "text": "MPI’s and Cigna’s dismissal motions. MPI, which is represented by", "paragraph_id": "para_222" }, { "text": "Phelps Dunbar LLP, did not file a brief or otherwise participate in this", "paragraph_id": "para_223" }, { "text": "appeal.", "paragraph_id": "para_224" }, { "text": "10", "paragraph_id": "para_225" }, { "text": "“Congress determines who may sue to enforce federal law.”", "paragraph_id": "para_226" }, { "text": "FS Credit Opportunities Corp. v. Saba Cap. Master Fund, Ltd., 608 U.S.", "paragraph_id": "para_227" }, { "text": "608, 613 (2026). “When Congress creates a private right of action, it", "paragraph_id": "para_228" }, { "text": "usually does so expressly.” Id. Although the Supreme Court once", "paragraph_id": "para_229" }, { "text": "“stood ready to let” “[p]rivate litigants . . . sue to enforce statutes that", "paragraph_id": "para_230" }, { "text": "lack” express private causes of action, it has “since rejected the", "paragraph_id": "para_231" }, { "text": "practice of fashioning rights of action as [it] see[s] fit.” Id. “That is", "paragraph_id": "para_232" }, { "text": "so because home-grown causes of action are difficult to reconcile with", "paragraph_id": "para_233" }, { "text": "the Constitution’s separation of legislative and judicial power.”", "paragraph_id": "para_234" }, { "text": "Cisco Sys., Inc. v. Doe I, 146 S. Ct. 1882, 1890 (2026) (cleaned up).", "paragraph_id": "para_235" }, { "text": "The Supreme Court thus has “strictly curtailed the authority of", "paragraph_id": "para_236" }, { "text": "the courts to recognize implied rights of action.” Lopez v. Jet Blue", "paragraph_id": "para_237" }, { "text": "Airways, 662 F.3d 593, 596 (2d Cir. 2011). In Alexander v. Sandoval,", "paragraph_id": "para_238" }, { "text": "532 U.S. 275 (2001), the Court required “that a review of the text and", "paragraph_id": "para_239" }, { "text": "structure of a statute yield a clear manifestation of congressional", "paragraph_id": "para_240" }, { "text": "intent to create a private cause of action before a court can find such", "paragraph_id": "para_241" }, { "text": "a right to be implied.” Jet Blue, 662 F.3d at 596; see Sandoval, 532 U.S.", "paragraph_id": "para_242" }, { "text": "at 286–87.", "paragraph_id": "para_243" }, { "text": "Following that approach, we first consider the statute’s text and", "paragraph_id": "para_244" }, { "text": "determine “whether the statute uses rights-creating language,", "paragraph_id": "para_245" }, { "text": "meaning language that focuses on the individuals protected rather", "paragraph_id": "para_246" }, { "text": "than the person regulated.” Murphy Med. Assocs., LLC v. Yale Univ.,", "paragraph_id": "para_247" }, { "text": "120 F.4th 1107, 1112 (2d Cir. 2024) (cleaned up). “Next, we consider", "paragraph_id": "para_248" }, { "text": "whether the statute’s methods of enforcement manifest an intent to", "paragraph_id": "para_249" }, { "text": "create a private remedy, as opposed to empowering agencies to", "paragraph_id": "para_250" }, { "text": "enforce their regulations.” Id. (cleaned up). In conducting this", "paragraph_id": "para_251" }, { "text": "11", "paragraph_id": "para_252" }, { "text": "analysis, we have emphasized repeatedly that “implied rights of", "paragraph_id": "para_253" }, { "text": "action are disfavored.” Moya v. U.S. Dep’t of Homeland Sec., 975 F.3d", "paragraph_id": "para_254" }, { "text": "120, 128 (2d Cir. 2020) (cleaned up); see Hallwood Realty Partners, L.P.", "paragraph_id": "para_255" }, { "text": "v. Gotham Partners, L.P., 286 F.3d 613, 618 (2d Cir. 2002).", "paragraph_id": "para_256" }, { "text": "B. Analysis", "paragraph_id": "para_257" }, { "text": "ECAPS contends that the NSA contains an implied private", "paragraph_id": "para_258" }, { "text": "right of action for an out-of-network provider to enforce payment", "paragraph_id": "para_259" }, { "text": "awards obtained through the IDR process. 5 We disagree. The", "paragraph_id": "para_260" }, { "text": "NSA’s text and structure do not “yield a clear manifestation of", "paragraph_id": "para_261" }, { "text": "congressional intent to create a private cause of action” to enforce IDR", "paragraph_id": "para_262" }, { "text": "awards. Jet Blue, 662 F.3d at 596. We thus join the Fifth Circuit in", "paragraph_id": "para_263" }, { "text": "holding that the NSA does not imply a private right of action to", "paragraph_id": "para_264" }, { "text": "enforce IDR awards. See Guardian Flight, L.L.C. v. Health Care Serv.", "paragraph_id": "para_265" }, { "text": "Corp., 140 F.4th 271, 274–77 (5th Cir. 2025).", "paragraph_id": "para_266" }, { "text": "1. Text", "paragraph_id": "para_267" }, { "text": "The NSA lacks an express private right of action to enforce IDR", "paragraph_id": "para_268" }, { "text": "awards, so “we begin with the presumption that Congress did not", "paragraph_id": "para_269" }, { "text": "5 Whether the NSA implies a private cause of action to enforce IDR", "paragraph_id": "para_270" }, { "text": "awards is an issue that has divided district courts, including in this Circuit.", "paragraph_id": "para_271" }, { "text": "Compare, e.g., Guardian Flight LLC v. Aetna Life Ins. Co., 789 F. Supp. 3d 214,", "paragraph_id": "para_272" }, { "text": "229 (D. Conn. 2025) (concluding that “the NSA creates a private cause of", "paragraph_id": "para_273" }, { "text": "action to enforce IDR awards”), with Axis Neuromonitoring, LLC v. Aetna Inc.,", "paragraph_id": "para_274" }, { "text": "824 F. Supp. 3d 217, 224 (D. Conn. 2026) (“The Court . . . concludes, as have", "paragraph_id": "para_275" }, { "text": "most courts to consider the issue, that the NSA does not create an implied", "paragraph_id": "para_276" }, { "text": "right of action.”).", "paragraph_id": "para_277" }, { "text": "12", "paragraph_id": "para_278" }, { "text": "intend one.” Bellikoff v. Eaton Vance Corp., 481 F.3d 110, 116 (2d Cir.", "paragraph_id": "para_279" }, { "text": "2007).", "paragraph_id": "para_280" }, { "text": "The NSA’s text does not overcome that presumption. To start,", "paragraph_id": "para_281" }, { "text": "the NSA incorporates the FAA’s provision for vacating arbitral", "paragraph_id": "para_282" }, { "text": "awards, see 29 U.S.C. § 1185e(c)(5)(E)(i)(II) (incorporating 9 U.S.C.", "paragraph_id": "para_283" }, { "text": "§ 10(a)), but not for confirming them, see 9 U.S.C. § 9. By contrast,", "paragraph_id": "para_284" }, { "text": "Congress has incorporated the FAA’s provision for confirming", "paragraph_id": "para_285" }, { "text": "arbitral awards in other statutes. See 5 U.S.C. § 580(c) (“A final", "paragraph_id": "para_286" }, { "text": "award is binding on the parties to the arbitration proceeding, and may", "paragraph_id": "para_287" }, { "text": "be enforced pursuant to sections 9 through 13 of title 9.”). The NSA’s", "paragraph_id": "para_288" }, { "text": "cross-reference to the FAA’s vacatur provision but not its", "paragraph_id": "para_289" }, { "text": "confirmation provision thus strongly suggests that Congress did not", "paragraph_id": "para_290" }, { "text": "intend to create a private right of action to enforce IDR awards. See", "paragraph_id": "para_291" }, { "text": "Guardian Flight, 140 F.4th at 276–77.6", "paragraph_id": "para_292" }, { "text": "To be sure, the NSA does use rights-creating language, but that", "paragraph_id": "para_293" }, { "text": "is not conclusive. It states that the plan or coverage “shall pay a total", "paragraph_id": "para_294" }, { "text": "plan or coverage payment directly” to the provider based on a", "paragraph_id": "para_295" }, { "text": "statutory formula. 29 U.S.C. § 1185e(b)(1)(D); see id.", "paragraph_id": "para_296" }, { "text": "§ 1185e(a)(1)(C)(iv)(II). And when the payment amount is", "paragraph_id": "para_297" }, { "text": "determined through the IDR process, the payment “shall be made", "paragraph_id": "para_298" }, { "text": "directly to the . . . provider . . . not later than 30 days after the date on", "paragraph_id": "para_299" }, { "text": "6 ECAPS contends that Congress did not need to incorporate the", "paragraph_id": "para_300" }, { "text": "FAA’s confirmation provision because that provision applies to awards", "paragraph_id": "para_301" }, { "text": "resulting from arbitration agreements rather than from a process mandated", "paragraph_id": "para_302" }, { "text": "by statute. This argument fails because Congress still incorporated FAA", "paragraph_id": "para_303" }, { "text": "§ 10, which also applies to awards resulting from arbitration agreements.", "paragraph_id": "para_304" }, { "text": "See 9 U.S.C. § 10(b).", "paragraph_id": "para_305" }, { "text": "13", "paragraph_id": "para_306" }, { "text": "which such determination is made.” Id. § 1185e(c)(6). These shall-", "paragraph_id": "para_307" }, { "text": "pay provisions reflect “the type of rights-creating language that we", "paragraph_id": "para_308" }, { "text": "have previously held may imply a cause of action.” Murphy, 120", "paragraph_id": "para_309" }, { "text": "F.4th at 1112.", "paragraph_id": "para_310" }, { "text": "But it is not enough that Congress uses rights-creating", "paragraph_id": "para_311" }, { "text": "language; it must also manifest an intent to provide for private", "paragraph_id": "para_312" }, { "text": "enforcement. See, e.g., id. at 1112–13. So “even where a statute is", "paragraph_id": "para_313" }, { "text": "phrased in . . . rights-creating terms, a plaintiff suing under an implied", "paragraph_id": "para_314" }, { "text": "right of action still must show that the statute manifests an intent ‘to", "paragraph_id": "para_315" }, { "text": "create not just a private right but also a private remedy.’” Gonzaga", "paragraph_id": "para_316" }, { "text": "Univ. v. Doe, 536 U.S. 273, 284 (2002) (quoting Sandoval, 532 U.S. at", "paragraph_id": "para_317" }, { "text": "286). The NSA does not manifest an intent to create a private", "paragraph_id": "para_318" }, { "text": "remedy.", "paragraph_id": "para_319" }, { "text": "2. Statutory Scheme", "paragraph_id": "para_320" }, { "text": "Congress created in the NSA a comprehensive regulatory", "paragraph_id": "para_321" }, { "text": "framework for setting up and enforcing the IDR process. On the", "paragraph_id": "para_322" }, { "text": "front end, Congress tasked three agencies—DOL, Treasury, and", "paragraph_id": "para_323" }, { "text": "HHS—with establishing the IDR process, including the certification", "paragraph_id": "para_324" }, { "text": "of IDR entities and the development of the methodology for", "paragraph_id": "para_325" }, { "text": "determining award amounts. See 29 U.S.C. § 1185e(a)(2), (c)(2)(A),", "paragraph_id": "para_326" }, { "text": "(c)(4)(A), (c)(5)(C)(i) (DOL); I.R.C. § 9816(a)(2)(B), (c)(2)(A), (c)(4)(A),", "paragraph_id": "para_327" }, { "text": "(c)(5)(C)(i) (Treasury); 42 U.S.C. § 300gg-111(a)(2)(B), (c)(2)(A),", "paragraph_id": "para_328" }, { "text": "(c)(4)(A), (c)(5)(C)(i) (HHS).", "paragraph_id": "para_329" }, { "text": "On the back end, Congress designed an interlocking federal", "paragraph_id": "para_330" }, { "text": "and state administrative scheme to enforce the NSA. First, DOL and", "paragraph_id": "para_331" }, { "text": "Treasury have the authority to address NSA violations by private", "paragraph_id": "para_332" }, { "text": "14", "paragraph_id": "para_333" }, { "text": "employer-sponsored group health plans. For instance, the Secretary", "paragraph_id": "para_334" }, { "text": "of Labor may bring a “civil action . . . to enjoin any act or practice", "paragraph_id": "para_335" }, { "text": "which violates any provision of” Subchapter I of ERISA, which", "paragraph_id": "para_336" }, { "text": "includes the NSA, or “to obtain . . . appropriate equitable relief (i) to", "paragraph_id": "para_337" }, { "text": "redress such violations or (ii) to enforce” those provisions, against", "paragraph_id": "para_338" }, { "text": "“any employee benefit plan” that is “established or maintained” “by", "paragraph_id": "para_339" }, { "text": "any [non-governmental] employer engaged in commerce.” 29", "paragraph_id": "para_340" }, { "text": "U.S.C. §§ 1132(a)(5), 1003(a).7 So DOL may file civil lawsuits against", "paragraph_id": "para_341" }, { "text": "non-compliant private-sector group health plans to enforce", "paragraph_id": "para_342" }, { "text": "compliance with the NSA’s IDR process. And Treasury may impose", "paragraph_id": "para_343" }, { "text": "“a tax on any failure of a [non-governmental] group health plan to", "paragraph_id": "para_344" }, { "text": "meet the requirements of chapter 100” of the Internal Revenue Code,", "paragraph_id": "para_345" }, { "text": "which contains the NSA as well. I.R.C. § 4980D(a); see id. §§ 9816,", "paragraph_id": "para_346" }, { "text": "9834. 8 Treasury thus may impose a tax when non-governmental", "paragraph_id": "para_347" }, { "text": "group health plans fail to pay IDR awards within 30 days.", "paragraph_id": "para_348" }, { "text": "Second, HHS has the authority to respond to NSA violations by", "paragraph_id": "para_349" }, { "text": "state and local governmental group health plans. The Public Health", "paragraph_id": "para_350" }, { "text": "Service Act provides that “any non-Federal governmental plan that is", "paragraph_id": "para_351" }, { "text": "7 Subchapter I of ERISA does not apply to any “governmental plan,”", "paragraph_id": "para_352" }, { "text": "which includes any employee benefit plan established or maintained by the", "paragraph_id": "para_353" }, { "text": "federal government or by a state government or subdivision. 29 U.S.C.", "paragraph_id": "para_354" }, { "text": "§§ 1002(32), 1003(b)(1).", "paragraph_id": "para_355" }, { "text": "8 A “group health plan” under the Internal Revenue Code includes", "paragraph_id": "para_356" }, { "text": "“a plan . . . of, or contributed to by, an employer . . . to provide health", "paragraph_id": "para_357" }, { "text": "care . . . to . . . employees.” I.R.C. § 5000(b)(1); see id. §§ 4980D(f)(1),", "paragraph_id": "para_358" }, { "text": "9832(a). The “term ‘employer’ does not include a Federal or other", "paragraph_id": "para_359" }, { "text": "governmental entity.” Id. § 5000(d).", "paragraph_id": "para_360" }, { "text": "15", "paragraph_id": "para_361" }, { "text": "a group health plan . . . that fails to meet a provision of . . . part D” of", "paragraph_id": "para_362" }, { "text": "Subchapter XXV, which also houses the NSA, “is subject to a civil", "paragraph_id": "para_363" }, { "text": "money penalty.” 42 U.S.C. § 300gg-22(b)(2)(A); see id. § 300gg-111.", "paragraph_id": "para_364" }, { "text": "So HHS may impose civil money penalties on state and local", "paragraph_id": "para_365" }, { "text": "governmental group health plans that do not timely pay IDR awards.", "paragraph_id": "para_366" }, { "text": "See E. Coast Advanced Plastic Surgery, 2025 WL 2371537, at *17", "paragraph_id": "para_367" }, { "text": "(observing that the IDR process is “subject to oversight and", "paragraph_id": "para_368" }, { "text": "enforcement by [HHS]”).9", "paragraph_id": "para_369" }, { "text": "Finally, the Public Health Service Act permits states to enforce", "paragraph_id": "para_370" }, { "text": "the NSA against health insurance issuers. The Act provides that", "paragraph_id": "para_371" }, { "text": "“each State may require that health insurance issuers that issue, sell,", "paragraph_id": "para_372" }, { "text": "renew, or offer health insurance coverage in the State in the individual", "paragraph_id": "para_373" }, { "text": "or group market meet the requirements of . . . part D” of Subchapter", "paragraph_id": "para_374" }, { "text": "XXV “with respect to such issuers.” 42 U.S.C. § 300gg-22(a)(1).", "paragraph_id": "para_375" }, { "text": "Congress thus contemplated state enforcement of the NSA, codified", "paragraph_id": "para_376" }, { "text": "in part D, against health insurance issuers.", "paragraph_id": "para_377" }, { "text": "Taken together, these provisions reflect “Congress’s policy", "paragraph_id": "para_378" }, { "text": "choice to enforce the [NSA] through administrative” action, “not a", "paragraph_id": "para_379" }, { "text": "private right of action.” Guardian Flight, 140 F.4th at 277. “The", "paragraph_id": "para_380" }, { "text": "express provision of one method of enforcing a substantive rule", "paragraph_id": "para_381" }, { "text": "9 ECAPS contends that HHS lacks jurisdiction over private", "paragraph_id": "para_382" }, { "text": "employer-sponsored group health plans. But, as noted, DOL and", "paragraph_id": "para_383" }, { "text": "Treasury may take enforcement action when such plans violate the NSA.", "paragraph_id": "para_384" }, { "text": "HHS’s authority to enforce the NSA against non-federal governmental", "paragraph_id": "para_385" }, { "text": "group health plans is part of the interlocking administrative enforcement", "paragraph_id": "para_386" }, { "text": "scheme that Congress created in enacting the NSA.", "paragraph_id": "para_387" }, { "text": "16", "paragraph_id": "para_388" }, { "text": "suggests that Congress intended to preclude others.” Sandoval, 532", "paragraph_id": "para_389" }, { "text": "U.S. at 290; see FS Credit, 608 U.S. at 616–17 (explaining that the", "paragraph_id": "para_390" }, { "text": "Securities and Exchange Commission’s “responsibility for ensuring", "paragraph_id": "para_391" }, { "text": "compliance” with the Investment Company Act, including the", "paragraph_id": "para_392" }, { "text": "agency’s power to “investigate and bring enforcement actions in", "paragraph_id": "para_393" }, { "text": "response to violations of” the Act and to “‘bring an action in . . . court’", "paragraph_id": "para_394" }, { "text": "for injunctive relief or civil monetary penalties,” “supports the", "paragraph_id": "para_395" }, { "text": "conclusion that private parties generally cannot enforce the” Act).", "paragraph_id": "para_396" }, { "text": "Here, Congress expressly provided for DOL and Treasury to enforce", "paragraph_id": "para_397" }, { "text": "IDR awards entered against private employer-sponsored group", "paragraph_id": "para_398" }, { "text": "health plans, for HHS to enforce awards against state and local", "paragraph_id": "para_399" }, { "text": "governmental group health plans, and for states to enforce awards", "paragraph_id": "para_400" }, { "text": "against health insurance issuers. This statutory scheme makes clear", "paragraph_id": "para_401" }, { "text": "that Congress did not intend to authorize private lawsuits to enforce", "paragraph_id": "para_402" }, { "text": "IDR awards.", "paragraph_id": "para_403" }, { "text": "3. ECAPS’s Other Arguments", "paragraph_id": "para_404" }, { "text": "ECAPS raises a host of counterarguments, but none is", "paragraph_id": "para_405" }, { "text": "persuasive. First, ECAPS observes that the NSA itself does not", "paragraph_id": "para_406" }, { "text": "confer enforcement authority on the agencies with jurisdiction over", "paragraph_id": "para_407" }, { "text": "private employer-sponsored group health plans—DOL and Treasury.", "paragraph_id": "para_408" }, { "text": "But Congress had no reason to do so because ERISA and the Internal", "paragraph_id": "para_409" }, { "text": "Revenue Code, each of which the NSA amends, already authorize", "paragraph_id": "para_410" }, { "text": "enforcement by those agencies. See Murphy, 120 F.4th at 1112", "paragraph_id": "para_411" }, { "text": "(declining to imply a private right of action in a statute that", "paragraph_id": "para_412" }, { "text": "“supplements” another statute containing an administrative-", "paragraph_id": "para_413" }, { "text": "enforcement provision); Jet Blue, 662 F.3d at 595, 597 (explaining that", "paragraph_id": "para_414" }, { "text": "17", "paragraph_id": "para_415" }, { "text": "a general enforcement provision in Title 49, which houses the Air", "paragraph_id": "para_416" }, { "text": "Carrier Access Act, supports the conclusion that the Act does not", "paragraph_id": "para_417" }, { "text": "imply a private cause of action).10", "paragraph_id": "para_418" }, { "text": "Second, ECAPS argues that DOL’s efforts to enforce the IDR", "paragraph_id": "para_419" }, { "text": "award provision are minimal. But the relevant question is whether", "paragraph_id": "para_420" }, { "text": "Congress authorizes agency enforcement, not how actively the", "paragraph_id": "para_421" }, { "text": "agency exercises its authority. See Murphy, 120 F.4th at 1112 (relying", "paragraph_id": "para_422" }, { "text": "on a statutory provision stating that a subsection “shall be applied by", "paragraph_id": "para_423" }, { "text": "the Secretary of Health and Human Services, Secretary of Labor, and", "paragraph_id": "para_424" }, { "text": "Secretary of the Treasury to group health plans”).", "paragraph_id": "para_425" }, { "text": "Third, ECAPS highlights that the Secretary of the Treasury may", "paragraph_id": "para_426" }, { "text": "waive the tax if the plan’s failure to pay IDR awards on time is not", "paragraph_id": "para_427" }, { "text": "due to willful neglect and that, for non-multiemployer plans, the tax", "paragraph_id": "para_428" }, { "text": "is imposed on the employer rather than on the plan. But the fact that", "paragraph_id": "para_429" }, { "text": "an agency may waive enforcement is not evidence of congressional", "paragraph_id": "para_430" }, { "text": "intent to permit a private right of action.11", "paragraph_id": "para_431" }, { "text": "10 Congress enacted ERISA’s agency-enforcement provisions in", "paragraph_id": "para_432" }, { "text": "1974. See Employee Retirement Income Security Act of 1974, Pub. L. No.", "paragraph_id": "para_433" }, { "text": "93-406, § 502(a), 88 Stat. 829, 891. It added the tax-penalty provisions to", "paragraph_id": "para_434" }, { "text": "the Internal Revenue Code in 1996. See Health Insurance Portability and", "paragraph_id": "para_435" }, { "text": "Accountability Act of 1996, Pub. L. No. 104-191, § 402(a), 110 Stat. 1936,", "paragraph_id": "para_436" }, { "text": "2084–87. These provisions long predate the NSA, which was enacted in", "paragraph_id": "para_437" }, { "text": "2020.", "paragraph_id": "para_438" }, { "text": "11 Nor does ECAPS identify any authority stating that agency", "paragraph_id": "para_439" }, { "text": "enforcement authority must exist over the noncomplying entity (here, the", "paragraph_id": "para_440" }, { "text": "plan) as opposed to over a separate entity (here, the employer). In any", "paragraph_id": "para_441" }, { "text": "18", "paragraph_id": "para_442" }, { "text": "Fourth, ECAPS argues that “Congress’s vesting of IDR", "paragraph_id": "para_443" }, { "text": "determinations with ‘binding’ effect is an[] indication of its intent to", "paragraph_id": "para_444" }, { "text": "render them judicially enforceable by providers.” Appellants’ Br. at", "paragraph_id": "para_445" }, { "text": "33–34. But this begs the question because the provision making the", "paragraph_id": "para_446" }, { "text": "IDR determination “binding upon the parties involved” says nothing", "paragraph_id": "para_447" }, { "text": "about who may enforce it. 29 U.S.C. § 1185e(c)(5)(E)(i)(I).12", "paragraph_id": "para_448" }, { "text": "Fifth, ECAPS’s invocation of cases involving the Tucker Act", "paragraph_id": "para_449" }, { "text": "and 42 U.S.C. § 1983 is inapposite. The Tucker Act waives sovereign", "paragraph_id": "para_450" }, { "text": "immunity “for certain damages suits in the Court of Federal Claims”", "paragraph_id": "para_451" }, { "text": "that are premised “on ‘other sources of law,’ like ‘statutes.’” Maine", "paragraph_id": "para_452" }, { "text": "Cmty. Health Options v. United States, 590 U.S. 296, 322 (2020). If a", "paragraph_id": "para_453" }, { "text": "statute “can fairly be interpreted as mandating compensation by the", "paragraph_id": "para_454" }, { "text": "Federal Government for the damage sustained,” it generally suffices", "paragraph_id": "para_455" }, { "text": "“to permit a Tucker Act suit for damages.” Id. at 322–23. This case", "paragraph_id": "para_456" }, { "text": "does not involve sovereign immunity, the Tucker Act, or the Act’s", "paragraph_id": "para_457" }, { "text": "“money-mandating inquiry,” id. at 323 n.12, so the Supreme Court’s", "paragraph_id": "para_458" }, { "text": "statement that “[s]tatutory ‘shall pay’ language often reflects", "paragraph_id": "para_459" }, { "text": "congressional intent to create both a right and a remedy under the", "paragraph_id": "para_460" }, { "text": "event, ECAPS concedes that DOL has authority over the private employer-", "paragraph_id": "para_461" }, { "text": "sponsored group health plans themselves.", "paragraph_id": "para_462" }, { "text": "12 ECAPS cites cases holding that a party may seek judicial", "paragraph_id": "para_463" }, { "text": "enforcement of an arbitral award where the award or the underlying", "paragraph_id": "para_464" }, { "text": "arbitration is “binding.” Appellants’ Br. at 34–36. Those cases are", "paragraph_id": "para_465" }, { "text": "inapposite. None of them addresses the NSA. None considers whether", "paragraph_id": "para_466" }, { "text": "a statute implies a private right of action to enforce an arbitration award", "paragraph_id": "para_467" }, { "text": "where the arbitration provisions are subject to administrative enforcement.", "paragraph_id": "para_468" }, { "text": "And several involve arbitration agreements, not a dispute-resolution", "paragraph_id": "para_469" }, { "text": "process created by statute.", "paragraph_id": "para_470" }, { "text": "19", "paragraph_id": "para_471" }, { "text": "Tucker Act” does not control here, id. at 324 (quotation marks", "paragraph_id": "para_472" }, { "text": "omitted). Moreover, in § 1983 cases, plaintiffs “do not have the", "paragraph_id": "para_473" }, { "text": "burden of showing an intent to create a private remedy because § 1983", "paragraph_id": "para_474" }, { "text": "generally supplies a remedy for the vindication of rights secured by", "paragraph_id": "para_475" }, { "text": "federal statutes. Once a plaintiff demonstrates that a statute confers", "paragraph_id": "para_476" }, { "text": "an individual right, the right is presumptively enforceable by § 1983.”", "paragraph_id": "para_477" }, { "text": "Gonzaga, 536 U.S. at 284 (internal citation omitted). That", "paragraph_id": "para_478" }, { "text": "presumption does not apply where the plaintiff sues under an", "paragraph_id": "para_479" }, { "text": "implied right of action. See id.", "paragraph_id": "para_480" }, { "text": "Sixth, ECAPS contends that declining to imply a private right", "paragraph_id": "para_481" }, { "text": "of action to enforce IDR awards would “render the incorporation of", "paragraph_id": "para_482" }, { "text": "section 10 of the FAA superfluous and absurd,” because there would", "paragraph_id": "para_483" }, { "text": "be no reason to provide “grounds for setting aside an award” if “no", "paragraph_id": "para_484" }, { "text": "plan or insurer [could] be compelled to pay an IDR award.”", "paragraph_id": "para_485" }, { "text": "Appellants’ Br. at 46. We disagree. As explained above, Congress", "paragraph_id": "para_486" }, { "text": "developed a comprehensive administrative scheme for enforcing the", "paragraph_id": "para_487" }, { "text": "NSA. A health plan or insurer may well prefer to seek vacatur of an", "paragraph_id": "para_488" }, { "text": "unfavorable IDR award under § 10 than to ignore the award and risk", "paragraph_id": "para_489" }, { "text": "administrative action. And if a provider believes the IDR process", "paragraph_id": "para_490" }, { "text": "was tainted and resulted in an award it thinks is too low, it may seek", "paragraph_id": "para_491" }, { "text": "vacatur as well.", "paragraph_id": "para_492" }, { "text": "Finally, ECAPS argues that denying a private enforcement", "paragraph_id": "para_493" }, { "text": "remedy “renders meaningless the entirety of the statutory IDR", "paragraph_id": "para_494" }, { "text": "regime.” Id. This is incorrect. Agencies may enforce the IDR", "paragraph_id": "para_495" }, { "text": "process, so the absence of a private right of action would not", "paragraph_id": "para_496" }, { "text": "undermine the process. “Congress may have judged it better to", "paragraph_id": "para_497" }, { "text": "20", "paragraph_id": "para_498" }, { "text": "have an administrative enforcement mechanism handle most award", "paragraph_id": "para_499" }, { "text": "disputes instead of throwing open the floodgates of litigation.”", "paragraph_id": "para_500" }, { "text": "Guardian Flight, 140 F.4th at 277.", "paragraph_id": "para_501" }, { "text": "In short, ECAPS has not shown that “Congress ‘affirmatively", "paragraph_id": "para_502" }, { "text": "contemplated’ a private right of action to enforce IDR awards.” Id.", "paragraph_id": "para_503" }, { "text": "We thus conclude that the NSA does not create an implied private", "paragraph_id": "para_504" }, { "text": "right of action to enforce payment awards obtained through the IDR", "paragraph_id": "para_505" }, { "text": "process.13", "paragraph_id": "para_506" }, { "text": "C. Declaratory Judgment Act", "paragraph_id": "para_507" }, { "text": "ECAPS contends that even if the NSA does not imply a private", "paragraph_id": "para_508" }, { "text": "cause of action to enforce IDR awards, a provider may still seek relief", "paragraph_id": "para_509" }, { "text": "13 Cigna contends that the NSA “bars providers from bringing", "paragraph_id": "para_510" }, { "text": "lawsuits to confirm IDR awards.” Appellees’ Br. at 21 (capitalization", "paragraph_id": "para_511" }, { "text": "omitted). It points to the NSA provision stating that a “determination of", "paragraph_id": "para_512" }, { "text": "a certified IDR entity . . . shall not be subject to judicial review, except in a", "paragraph_id": "para_513" }, { "text": "case described in any of paragraphs (1) through (4) of section 10(a) of [the", "paragraph_id": "para_514" }, { "text": "FAA].” 29 U.S.C. § 1185e(c)(5)(E)(i). Cigna maintains that the term", "paragraph_id": "para_515" }, { "text": "“judicial review” encompasses “lawsuits seeking to . . . confirm or enforce", "paragraph_id": "para_516" }, { "text": "a dispute resolution award.” Appellees’ Br. at 21 (emphasis omitted); see", "paragraph_id": "para_517" }, { "text": "Guardian Flight, 140 F.4th at 275–76 (adopting this interpretation). We", "paragraph_id": "para_518" }, { "text": "need not decide this issue. Assuming without deciding that the judicial-", "paragraph_id": "para_519" }, { "text": "review bar does not preclude ECAPS’s lawsuit, that fact alone is not “a clear", "paragraph_id": "para_520" }, { "text": "manifestation of congressional intent to create a private cause of action.”", "paragraph_id": "para_521" }, { "text": "Jet Blue, 662 F.3d at 596.", "paragraph_id": "para_522" }, { "text": "21", "paragraph_id": "para_523" }, { "text": "against a health plan under the Declaratory Judgment Act. This", "paragraph_id": "para_524" }, { "text": "claim is meritless.", "paragraph_id": "para_525" }, { "text": "As the district court correctly explained, the Declaratory", "paragraph_id": "para_526" }, { "text": "Judgment Act “does not create an independent cause of action.” E.", "paragraph_id": "para_527" }, { "text": "Coast Advanced Plastic Surgery, 2025 WL 2371537, at *18 (quoting", "paragraph_id": "para_528" }, { "text": "Chevron Corp. v. Naranjo, 667 F.3d 232, 244 (2d Cir. 2012)). A “court", "paragraph_id": "para_529" }, { "text": "may only enter a declaratory judgment in favor of a party who has a", "paragraph_id": "para_530" }, { "text": "substantive claim of right to such relief.” In re Joint E. & S. Dist.", "paragraph_id": "para_531" }, { "text": "Asbestos Litig., 14 F.3d 726, 731 (2d Cir. 1993). Without an implied", "paragraph_id": "para_532" }, { "text": "private right of action under the NSA, ECAPS has no other", "paragraph_id": "para_533" }, { "text": "substantive claim of right to relief, so its cause of action for failing to", "paragraph_id": "para_534" }, { "text": "make timely payment of IDR awards cannot proceed.", "paragraph_id": "para_535" }, { "text": "III. CONCLUSION", "paragraph_id": "para_536" }, { "text": "We have considered ECAPS’s remaining arguments and find", "paragraph_id": "para_537" }, { "text": "them to be without merit. 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