CMS audits identified flawed payment calculations, missing disclosures and air ambulance claims improperly excluded from No Surprises Act protections.
Patients should not need an auditor to make their insurance protections work. Yet two newly published federal audits show why oversight matters: the systems responsible for applying the No Surprises Act failed important compliance checks.
The findings reach beyond a technical argument over payment formulas. They concern the information providers receive and the protections patients should have when an emergency leaves them no choice about who delivers their care.
What the audits found
952 payment calculations
In its CareSource of Indiana audit, CMS identified an improper calculation method affecting 952 qualifying payment amounts, or QPAs, across 106 sampled claims. CareSource used usual-and-customary rates instead of the required contracted-rate methodology. CMS also identified missing disclosures and required a broader self-audit, including refunds wherever consumers paid excess cost-sharing.
2 air ambulance claims excluded
In the Ohio School Employees Retirement System plan, administered by Aetna, two of six reviewed air ambulance claims were incorrectly excluded from NSA processing. An erroneous retiree-only designation in the administrator’s system caused the problem. The audit also identified disclosure failures.
These are findings from specific audits, not estimates of nationwide error rates.
A protection is only as strong as its implementation
The qualifying payment amount is a benchmark used in patient cost-sharing and considered in federal payment disputes. When that calculation is wrong, or required information is missing, the process becomes harder to trust.
For air ambulance patients, the stakes are especially clear. They cannot shop for a different aircraft while facing a medical emergency. Their protection should not depend on whether an administrator’s system assigns the correct designation.
Big Insurance Watch believes the policy debate should scrutinize compliance with existing protections as closely as it scrutinizes arbitration outcomes. Before policymakers weaken the tools available to resolve payment disputes, they should demand reliable calculations, complete disclosures and evidence that corrective actions work.
From findings to accountability
Our position is straightforward: publish audit findings, correct flawed processing, return excess patient payments and verify that the fixes hold. Promises of coverage must translate into protections that actually function.
These audits complement the accountability questions raised in M. Dylan McClelland’s Los Angeles Times op-ed. They also connect to the access concerns explored in our Red Bluff Watch File: the rules governing emergency care need to work in practice.
Scope and follow-through
Both audits cover services from January 2022 through May 2023 and describe corrective actions. They do not establish that every calculation error reduced provider payments or that the failures were intentional. CMS recorded an Aetna system correction and accepted the plan’s rationale for not reprocessing the two identified claims, while requiring a broader review. We focus here on documented calculation, processing and disclosure failures, rather than the separate litigation over unused contracted rates.
Read the reporting and the records
TechTarget: Newly published NSA audits reveal QPA miscalculations (October 22, 2026)
Analysis by Big Insurance Watch, a project of the Emergency Air Rescue Alliance.