Nonprofit Arbitrators Profit Heavily Under No Surprises Act, Investigation Finds

October 19, 2026 - 13:01

A recent investigation has uncovered that several nonprofit organizations are earning substantial revenue by serving as arbitrators in a federal program designed to shield patients from unexpected medical bills. The findings raise questions about whether the system meant to resolve billing disputes fairly is instead enriching the very entities tasked with overseeing it.

The No Surprises Act, enacted to protect consumers from surprise out-of-network charges, established a dispute resolution process where insurers and providers submit competing payment offers to an independent arbitrator. That arbitrator then selects one of the two amounts. According to the investigation, some nonprofits acting in this role have collected enormous fees while exercising broad authority over which party prevails in each case.

Critics describe these arbitrators as operating with little meaningful oversight, wielding outsized influence over financial outcomes for hospitals, doctors, and insurance companies alike. The arrangement has turned dispute resolution into a lucrative enterprise for certain organizations, with compensation far exceeding what many would expect for a nonprofit entity.

The investigation also highlights concerns about transparency. Details regarding how arbitrators are selected, how fees are structured, and how decisions are made remain largely obscured from public view. Patient advocacy groups argue that without clearer accountability, the program risks prioritizing profit over its original mission of protecting consumers.

Supporters of the current system maintain that arbitrators provide a necessary neutral function and that the volume of cases demands significant administrative capacity. Still, the scale of compensation uncovered has prompted calls for closer scrutiny and possible reforms to ensure the program serves patients rather than the interests of those administering it.