Delaware Court of Chancery Opinion on No Surprises Act

IN THE COURT OF CHAN CERY OF THE STATE O F DELAWARE SPECI A LTYC ARE, INC.; REM OT E NEUR OMO NITO RING P H YSICI ANS, PC; an d SENTIENT PHYSIC IANS, PC, Plain tiff, v. MEDCOS T, LL C, Defe nda nt.)))))))))))))) C.A. No. 20 25 - 0011 - DH REP OR T Report: Febr uary 16, 2026 Date S ubm itte d: Dec ember 02, 202 5 Jeffre y J. Lyons, Mic hae l E. Nemin ski, B AKE R & H OST ETL ER LL P, Wilm i ngton, DE; Atto rney s for Plainti ffs Sp ecialtyc are, I nc., R emote Ne urom onitoring Phys icia ns PC, an d Sent ien t Phy sici ans, P C. John M. Sea man, Fl ore ntina D. Fiel d, AB RAMS & B AYLI SS, Wilmi ngt on, DE; Brad ley A. Ro hren bec k, Cha se St eve ns, KILPATRICK, TO WNSEND A ND STOCKTON, LL P, Wins ton - Salem, NC; Attorn ey s for Defend ant MedCost, LLC.

2 HUME, IV, M. Toda y, the Co urt a ddr esse s a n arr ow que sti on of fir st im pres sio n in De la ware: whet her the Feder al No Sur pris es Act contains an implie d private right of a ction to enfor ce a ward s dete rmin ed un der the In ter nal D ispute Res olut ion P roce ss. 1 While Plain tiff seek s enf or ceme nt of the a war ds b y ap peal t o the Cour t of Cha ncer y’s exclu sive juri sdic tio n to en forc e ar bitra tion agre eme nts, t he sta tut ory d ispu te resol uti on pr oces s dif fers f ro m ar bitra tio n as def ined in the Fe der al Ar bitra tio n an d Del aware Unifor m A rbitra tio n Ac ts. Mor eover, under the pr incip les of stat utor y inter pre tati on promulga ted by the U.S. Suprem e Cour t in Alexander v. Sa ndov al 2 and in ke ep ing wi th sev era l Dis trict C our t deci sio ns inte rpr etin g the N o Sur pri se s Act, this C our t dec line s to crea te a priv ate r ight of ac tion. These counts are dism isse d. The Cou rt fur the r di smis ses Pl aint iff’ s thre e al terna tive cau ses o f ac tion for fa ilure to st ate a cla im u nder C our t of Cha ncer y R ule 12(b)(6). 1 See 42 U.S.C. §§ 300g g-111 et seq. 2 532 U.S. 275, 2 86 (200 1). As disc ussed infra, Delaware c ourts have long follo wed federal precedent in determin ing whet her a priv ate right of action exists. See, e.g., Mann v. Oppenheimer & Co., 5 17 A.2d 1056, 10 64 (Del. 1986).

3 I. BACKG RO UND 3 Plain tiff s Spe cia ltyC are, Inc., Rem ote Ne urom onit orin g Ph ysic ians, P C, an d Sentie nt P hysic ian s, PC initiat ed this act ion aga inst De fen dan t MedC ost, LLC. The facts are drawn f rom the Verif ied C omp lain t and are take n to be tr ue f or t he pu rpos e s of this Mot ion to D ismis s. A. Conte nt and Structure of the No Surprises Act I n late 20 20, th e Pre side nt s ign ed in to law th e No S urpr ise s Ac t (“NS A” or “Act”) to def ray c ons umer c osts ar isi ng fr om “une xpe cted o ut - of - network m edical bills. ” 4 The Act lim its “t he amo unt an i nsur ed pa tien t will pa y for em erg ency servic es fur nis hed by a n out - of - network provider.” Tex as Med. Ass ’n v. U.S. Dep’t of Heal th & Hum. Serv s., 654 F. Supp. 3d 575, 5 80 (E. D. Te x. 2 023). T he Ac t als o limi ts how muc h an ins ured pa rty pa ys for “ce rta in non - e mer genc y ser vices furni shed by a n ou t - of - ne twor k p rovi der at an i n - ne twor k fa cili ty.” Texas Med. 3 Unless otherwise n oted, pleadi ngs are cited by reference to items do cketed in C.A. No. 2025-0011- DH (“D.I.”). At the ti me of this ruling, only the draft transcript has been prepared and citations t o it refer to the rough c opy of the transcript (“ Draft Tr.”), D.I. 30. Citations in the form of “Compl.” refer to P laintiff’s Verif ied Compla int, D.I. 1. Citations in the form of “DOB” refer to Defend ant’s Brief in Suppor t of Motio n to Dismiss, D.I. 1 3. Citations in the form of “PAB” refer to Pla intiff’s Answerin g Brief in Oppositio n to Defendant’s Motion t o Dismiss, D.I. 2 0. Citations i n the form of “DRB” refer to Defendant’s Reply Brie f in Support of Mo tion to Dismiss, D.I. 22. Her e, “Supreme Court” refers to the U.S. Supre me Court rather tha n the Delaware Supreme C ourt. 4 The No Surprises Act at a Glance: Protect ing Consumers A gainst Unexpected Medical Bills, C TRS. FOR M EDI CARE & M EDI CAID S ERVS. (Jan. 2025), https://www.cms.gov/fi les/document/nsa- at -a-glance.pdf.

4 Ass ’ n v. U.S. D ep’t of He alt h & Hum. Serv s., 110 F.4 th 762, 767 (5th Cir. 20 24) (quot ing Texas Me d. A ss ’n, 654 F. Supp. 3d at 58 0). The Act we nt into e ffec t on Januar y 2, 202 2. 5 In sit uati ons where an i nsur ed per son incur s e merge ncy m ed ical cost s out of netw ork (“OON”) 6, the NS A cra fted a proce dur e for the hea lthca re prov ider a nd i nsure r t o all ocate co sts. I nit iall y, ins ura nce pla ns an d issuer s may pa y the OO N prov ider whatever amount t hey p ref er. 7 I f th e healthcar e provid er wishes to co ntes t the ins urer’ s init ial p aym ent, the prov ider “ ini tiate [s] open nego tiat ion s” withi n thirt y days of the paym en t. 42 U.S.C. § 300gg - 111(c)(1)(A). Wh er e th e open ne got iati ons per iod fa il s to resolv e the pa yment dis pute, eith er par ty c an initia te the In depe nde nt Di sp ute Re solu tio n Pr oces s (“I DR”), a “base bal l - style” 8 resol ution proce ss wher e a third - party referee (“IDR E nti ty”) determ ines the a mou nt o wed b y 5 Compl. ¶ 9. 6 An example of this is when an emergen t patient is airlifted to a medical faci lity by a n OON medical transport helicopter. 7 Compl. ¶ 10. Although the NSA app lies both to insurance pla ns and issuers, the o pinion refers just to “plans” fo r ease of reading. 8 “Baseball - style” arbitration refer s to the a rbitration pr ocess employed by Major League Baseball. In tha t proce eding, the te am and player each sub mit a prop osed salary figure to a panel of arbitrators. The arbitr ation panel chooses t he player’s or t eam’s proposal and is not free to select a figure not suggested by o ne of the sides. See Salary Arbitr ation and Arbitration Eligibilit y, MLB. COM https://www.mlb.com/gl ossary/transactio ns/salary- arbitration (last visited Feb. 16, 2026).

5 the p lan. 9 Id., § 300 gg -111(c)(1)(B). E ithe r the par ties or the Depa rtme nt of Hea lth and Hu man Servi ces selects the IDR entity. 42 U.S.C. § 300gg - 111(c) (4); Gu ardian Flight, L.L.C. v. Healt h Care Ser v. Cor p., 140 F. 4th 2 71, 273 (5 th Cir. 2025) (disc uss ing the NS A’s s truct ure). Duri ng the IDR proce ss, ea ch par ty submits a n offer f or what is owe d a nd an y addi tiona l inf orma tio n re ques ted by the I DR E nt ity. Then, the IDR E ntity sele cts one of the of fer s f ollow ing c ons idera tion of nu mer ous s tatu tori ly pre scr ibe d consi deratio ns. 42 U.S.C. §§ 300 gg - 11 1(c)(5)(A), (C)(i) – (ii). The IDR Ent ity’s deter mination is bind ing on the par tie s “in the a bsen ce of a f raudu len t clai m o r evide nce o f misr epr ese ntat ion of fac ts pr esen ted t o the I DR ent ity in volve d regar din g suc h clai m [.]” Id. § 300gg - 111(c)(5)(E)(i)(I). 1. The I DR st atut e in corp orat es one p rovi sion of t he Fe der al Arbit rati on Act for ju dicia l rev iew of I DR ent ity’s d ecis ion in case s of f rau d, m ista ke, or c orr upti on. The NSA pro vide s that the dete rmin ati on “ shal l no t be s ubje ct to judic ia l revie w” ex cept f or th e circ umsta nce s desc ribe d in 9 U.S. C. Section 10(a)(1) –(4). 42 U.S.C. § 30 0gg -111(c)(5)(E)(i) (II). Secti on 10 is a provi si on of t he Fed era l Arbi trati on Ac t (“F AA”), wh ich pr ovi des i n rele van t part: 9 The Complaint incorrectly refers to the IDR E ntity as a “third- party a rbitrator.” ¶ 10. As I explain infra, the IDR E ntity is no t an arb itrator but a dis tinct third - party resolution process unique to the N SA’s statutory fra mework.

6 (a) In any of t he f ollo wing case s the Un ited Stat es c our t in a nd f or the distr ict w here in the awar d was ma de may make a n order vaca tin g the awa rd upon t he a pplic ati on of a ny par ty t o the a rbi trat ion -- (1) where the a war d was pr ocure d b y corru pti on, fr aud, or un due means; (2) where there w as evident pa rt iali ty or corr upt ion in the arbitr ato rs, or eit her of them; (3) where the ar bitr ator s were guilt y of mi scon duct i n ref using t o postp one t he he arin g, upon s uff icien t ca use shown, or i n ref usin g to hear evi dence pert ine nt and m ater ia l to t he con trover sy; or of any oth er mis behav io r by which the righ ts of any pa rty ha ve b een preju dice d; or (4) where the ar bitr at ors exc eede d the ir p owers, or so impe rfec tly exec uted t hem tha t a mutua l, fina l, a nd def init e awar d upon t he subje ct ma tter subm itted was n ot ma de. Thus, the NS A inc orpor ate s one d iscret e pro visi on of t he FAA so that C our ts ma y rever se the IDR E ntit y’s dete rmi nati on in sit uati ons of exc ept iona l misco nduc t. The NS A incl ude s an a dmin istra tive a cco unta bil ity mec ha nism f or sit uati ons of misc onduc t not co ntem pla ted b y 9 U.S. C. Sect ion 10. The Secr etar ies of He al th and H uman S ervic es (“ HHS”), Labor, and Tre asury may subm it repor ts to C ongress rega rding pla ns that engag e in “a pat tern or pract ice of rou tine de nia l, low paym ent, or dow n - cod ing of claim s,” w ith “r eco mm endat ion s on wa ys to disc oura ge s uch a pattern or practice. ” 42 U. S.C. § 300gg - 1 11(c)(5) (E)(iv). 2. The Fed era l and Del aware Unif orm Arbi trat ion Ac ts pr ovid e cause s of acti on for en force ment of arbi trat ion deci sion s. While the NS A lim its ju dic ial re view to case s inv olv ing mi sco nduc t, par tie s subje ct t o an ar bitr ato r’s de cis ion un der t he FAA m ay seek judicial con firmat ion or rev iew. 9 U.S.C. Sec tion 9 per mit s any c ourt of c ompete nt j uris dict ion t o enter an

7 order conf irm ing a vali d arbi tra tion a ward “unle ss t he aw ard is vaca ted, mod ified or corre cte d as pr escr ibe d in se ctio n 10 a nd 1 1 of thi s tit le.” 10 The FAA co ntem plate s that t he pre va iling par ty in a rbit rati on c an o btai n a Cour t or der c onfi rmin g the a war d, unle ss a part y seeks to a lter or va cate the arbitr ator’ s deci sion, in whi ch cas e the partie s pr oper ly pr oce ed un der S ecti on 10 (vacat ing a n awa rd on grou nds of misco nduc t) or Sect ion 11 (“mo dify ing or cor rec ting a n aw ard” on g rou nds of mista ke, m iscalc ulat ion, or ove rbreadth). The De lawa re Un iform Arbi trati on Act (“D UAA”) 11 provi des com para b le juri sdic tion f or a c our t to m odif y, con firm, or vac ate a n awar d. The Dela ware C our t of Cha ncer y has exclusi ve ju risdi ction for j udic ial revi ew of DUAA a rbitrati ons absen t expr es s agre eme nt of the par ties. See 10 De l. C. § 5702(a). The requi rements for c onfirm at ion of an ar bitr ator ’s de cis ion la rge ly mim ic s the FAA, where a par ty need o nly ma ke i ts ap plica tio n to the revie win g cou rt within on e year of the arbitr at or’s de cis ion. Id. § 5713. The n on - pre vail ing par ty in a DU AA ac tion m a y 10 The FAA permits parties to designate the reviewing court, with the “ United States court in and for the district w ithin which such award was made” functioning as the default venu e absent express stipul ation. 9 U.S.C. § 9. For parties seeking vacatu r of the arbitrator’s decision under Section 10 of the FAA, howe ver, “the United States court in and for the district wherein the a ward was made ” has exclusive jurisdic tion. When a party seeks judicial review or confi rmation in Delaware state court, however, t he Court of Chancery is vested with exclusive j urisdiction. See 10 Del. C. § 570 2(c). 11 10 Del C. § 57 01 et seq. The Court of Chanc ery possesses ju risdiction to co nfirm and review arbitration awards under the F AA, provided the partie s agreed to jurisdictio n within Delaware. Id. § 5702.

8 seek va cat ur of th e awar d on the same groun ds esta bli she d wit hin the FAA. Compa re 10 D el. C. § 5714(a)(1) - (5), with 9 U.S.C. § 10 (a)(1) – (5). T he DUAA modif ica tion or corr ect ion s tatu te als o la rge ly para lle ls the FAA ’s, a lthou gh t he DUAA impose s a nine ty - day time lim it t o seek s uch am endm ent. Comp are 10 Del. C. § 5715(a)(1) – (3), with 9 U. S.C. § 11(a) – (c). Regar dles s of wh ethe r an a rbitr atio n proc e eds un der the FAA or the DUA A, the re lev ant stat utes prov ide a n expr es s caus e of acti on f or an y ar bitra tin g par ty t o confir m, va cate, or mod ify t he awa rd. B. S pecia ltyCare and Me dCos t engag ed in numerous IDR pr oce sse s to re solve paym ent dispu tes. S pecia ltyC are, Inc. (“Spec ialt yCa re”) is a Dela ware cor pora tio n wit h it s princ ipal p lac e of bus ines s in Bre ntw ood, Tenne ssee. Spec ial tyC are is a h ealt h care prov ider of intr ao pera tive neur omon ito ring thro ughou t the Unit ed Sta te s. 12 Spec ialt yCar e claim s that i t “ins ure s and a dmin ister s he alt h ins ura nce pr oduc ts a nd benef it pla ns.” 13 Spec ialt yCar e has two af fi liat e ent itie s: Re mote Neur omo nitor in g 12 Compl. ¶ 3. 13 Id., ¶ 4. MedCost argues in its briefing that it is not a licensed ins urer but a “standalone preferred provider net work” that contrac ts with provid ers to “provi de network access to insurers and third - pa rty health plan ad ministrators .. . .” D OB, at 3. MedCost expl ains that it is not listed a mong Insurance Companies on North Caro lina’s administrative database. See North Carolina D ep’t of Ins., Listing of Insurance Companie s and Oher Regulated Entities, tps://www.ncdoi. gov/insuranc e-industry/financial-

9 Physi cians, PC (“Remo te Neuromoni torin g”), a Pennsylva nia entity, and Sentient Phys ician s, PC (“S en tien t Phy sicia ns”), an Illi noi s ent ity, bot h wi th the ir princ ipal place of busi ness i n Bren twoo d, Ten ness ee. 14 MedCost, LLC (“MedCost”), is a Delaw are L LC wi th its princ ipal plac e of bu sine ss in W ins ton - Salem, North Carol ina. 15 Foll owing the NS A’s imp leme nta tion, Spec ialt yCare e nga ged in mul tip le ID R deter min atio ns wit h MedC ost. 16 Follow ing such det erm inat ion s, Med Cost owes $198, 871 to S pecia ltyC are that rem ains unpaid. 17 Specia ltyC are fur the r clai ms th at it co ntinue s to e nga ge in tra nsac tion s wi th MedC o st, and that it ex pec ts fur ther IDR deter min atio ns, w hich m ay i ncrea se th e debt owed. 18 analysis/listinginsuranc e-companies-and-ot her-regulat ed - en tities; DOB, at 3 n.2. While I can properly take judi cial notice of pu blicly available facts not su bject to reasonable dispute, I decline to re solve the parties’ dispute whether MedCost is or is not a G roup Health plan subje ct to the NSA’s ID R proceedings and limit the factual sco pe of my analysis to the pleadin gs. Cf. In re General Motors (Hughes) S’h older Litig., 8 97 A.2d 162, 17 1 (Del. 2 006) (affirmi ng the Trial Court’s decisio n to ta ke judicial n otice of stockholder vote totals memorialized in an S EC Form 10 - Q because it was not subject to reasonable dispute); D. R.E. 201. 14 Id., ¶ 3. 15 Id., ¶ 4. 16 Id., ¶¶ 13, 16. 17 Id., ¶ 15. SpecialtyC are submi tted a chart identifying all unpaid ID R awards bet ween the parties. See id., Ex. A. 18 Id., ¶¶ 20–21.

10 Speci altyCa re claims th at MedCost ini tially m akes low pa yments wh en OON claim s are s ubm itte d, in the h ope th at Spe cia ltyCa re wi ll ne glect t o purs ue the NSA’ s resol uti on pr oces s, t here by lim iti ng M edC ost’s over al l lia bility. 19 Eve n w here Spec ialt yCar e does s eek I DR res olu tion f or the d isp uted cl aim s and t he IDR e nti ty deter min es the awar d, Med Cost de lays pa yme nt past the thir ty - da y stat utor y deadl ine. 20 C. Spec ialty Care fil es s uit be fore thi s Cou rt to con firm the awar ds or obtain alt ern ate r elief. F ollow ing Me dC ost’ s failu re t o rem it pay ment f or the I DR d eter mina tio ns, Spec ialt yCar e brou gh t suit in this C our t on Ja nuar y 3, 2025, a lleging f ive counts. 21 Spec ialt yCar e bri ngs two c ount s see king conf irma tion of t he I DR awa rd s unde r DUAA S ecti on 5 702 a nd FA A Sec tion 9. 22 In additi on to this or der, Specia ltyC ar e looks to ob tain pr e - and post - jud gment inter est on the bala nce of unp aid a war ds under 2 8 U.S. C. § 1 961. In the alte rna tive, Spec ialt yCa re se eks re lief o n thre e 19 Id., ¶¶ 22–23. 20 Id., ¶ 24. 21 See id. 22 Id., ¶¶ 27 –40.

11 grou nds: f irst, unde r the theor y of a n ac coun t sta ted, 23 secon d, o n grou nds of quant um meruit, 24 and third, on grou nds of un jus t enrichm en t. 25 MedC ost filed a M otio n to Dismi ss for fail ure t o sta te a cl aim on Ma y 28, 2025. 26 The m atte r wa s re assi gne d to m e on Octo ber 8, 20 25, 27 and I h eard argume nt on the Mo tio n to Di smis s on Dece mb er 2, 2025. 28 I init iall y took the ma tter un der advi seme nt a nd now reco mme nd gr anti ng Me dC ost’ s Mot ion to Dis miss for the reas ons ar ticu late d be low. II. ANAL YSIS The st andard for a motio n to dism iss is we ll - sett led. When review ing a motio n to dism iss unde r C ourt of C ha ncer y Rule 12(b)(6), De lawa re c ourt s “(1) acce pt al l well plead ed fa ctua l a llega tio ns as true, (2) a ccep t eve n va gue allega tio ns as well plead ed if t hey gi ve the op pos ing pa rty no tice of the cla im, and dra w al l reas onab le infe rence s in favor of the no n - mo ving party. ” Cent. Mortg. Co. v. Morgan Stanl ey Mort g. Cap. Hldgs. L LC, 27 A. 3d 531, 535 (Del. 2011) (inte rna l 23 Id., ¶¶ 41–52. 24 Id., ¶¶ 53–66. 25 Id., ¶¶ 67–80. 26 D.I. 13. 27 D.I. 24. 28 D.I. 30.

12 citat ion s omit ted). “[T]he g over ning p lea ding sta nda rd in D elawar e to s urvi ve a motio n to di smiss is reas onab le conc eivabili ty.” Id. at 537 (i nter nal cit ations omit ted). The rea son able c onc eiva bil ity s tan dar d gra nts a pla intiff “a ll rea so nab le infer ence s tha t lo gica lly f low f rom the fac e of the c om plai nt” b ut doe s n ot ob liga te the C ourt “ to a cce pt e very s tra ine d inte rpre tat ion of the [p lain tiff’ s] all ega tion s.” In re Gene ral Moto rs (H ughe s) S ’ holder Lit ig., 897 A.2d 1 62, 16 8 (De l. 20 06) (q uot ing Malpie d e v. Townson, 780 A.2 d 10 75, 10 83 (De l. 2 001)). The Cour t will “ ign ore concl usor y alle gat ions tha t lac k spec ific sup port ing fact ual a lleg ati ons.” FM LS Hldng. Co. v. Inte gris Bi oService s, LLC, 20 23 WL 729 7238, at *5 (Del. Ch. Oct. 30, 2023) (quoting R amunno v. Ca wley, 705 A.2d 1 029, 1034 (De l. 1998). Dismissa l is appro priate w here “the [no nmov ing pa rty ] woul d not be ent itle d to rec ove r under any re aso nab ly co nceiva ble set of cir cum stances. ” AECOM v. S CCI Nat’l Hldngs., Inc., 2023 WL 6294985, at *6 (Del. Ch. S ep. 27, 2023) (quoti ng Cent ral Mortg. Co., 27 A.3 d at 535). A. The NS A provides neither an express n or implie d pr ivate righ t of action to con firm IDR En tity Awards. Thus, SpecialtyC are’s Count s I and II t o confirm the award s is dism issed. I first tur n to whethe r MedC ost posse sses prope r grounds t o seek enfor cem en t of the I DR bef ore th is Court. W hile the brief ings at tend t o whet her an im plie d priv ate right of action ar ises und er the NS A, I mus t first c onside r whethe r the Court of Chanc ery ha s sub ject matte r jurisd iction. S pecialt yCare brought t wo counts f or

13 enfor cem ent of the IDR dete rmi nation u nder FAA S ect ion 9 and DU AA Secti on 5702 r espec tivel y, wh ich conta in es sent ial j uris dict iona l elem ent s. W hile I hold th at this Co urt lacks su bject m atter j urisdic tion, I hold in th e alter native tha t Spec ialt yCar e fa iled to sta te a cla im becaus e the NSA does not give rise to a n implie d priva te righ t of act ion. 1. The partie s lack an arbitr ation agr eement. Thus, th e Court lacks subject matt er juri sdict ion over Spe cialty Care’ s motion t o confirm the I DR Entity’s O rder. The th resh old quest ion is whet her an IDR p rocee ding is an ar bitrati on subjec t to this C ourt’s conf irmatio n under 10 Del. C. § 5702(c). If an IDR pr ocee ding mater ially differs from an arbitra tion, then I c an not c onfir m the awa rd under the FAA’s S ection 9 a uthor ity or the com parable DUAA Section 5713. Because an IDR proce eding is not an arb itration, I dismi ss C ounts I an d II f or want of subjec t matte r juri sdictio n. While Med Cost st ylizes it s Motio n to Dis miss as f ailure to state a cla im und er Court of Chan cery Rule 1 2(b)(6), subject m atter juri sdic tion is “crucia l,” and [the Court] must “e nsure it exi sts, even if it mu st raise the issue s ua spon te.” Critc hfie ld v. Engf er, 2016 W L 275 5933, at *1 (D el. Ch. M ay 9, 20 16) (quot ing Appo quinimink Educ. Ass oc. v. Appoquin imin k Sch. Dis trict, 2003 WL 17 94963, at *3 (Del. Ch. Mar. 31, 20 03), corre cted (Apr. 17, 2003), aff’ d, 844 A.2 d 991 (Del. 2004); Ct. Ch.

14 R. 1 2(h)(1) (“ A part y may a ssert a defe nse unde r Rul e 12(b)(1) mot ion file d at an y time, or the Co urt may ra ise the def ense on its own ini tiative ”). A brie f look a t the hist ory of t he FA A reveal s that I DR pro ceedin gs are no t arbit rations becau se an agreem ent t o arbitr ate must ar ise out of a c ontract. S ection 2 comp rises the “pr imary su bsta ntive prov ision of the Act, ” Moses H. Con e Mem oria l Hos pital v. M ercur y Constru ction Corp., 460 U.S. 1, 24 (198 3), and prov ides in re leva nt part: A wri tten provi sion in a ny mariti me transa ction or a cont ract evide ncing a tra nsactio n invol ving com mer ce to se ttle b y arbi tration a contr oversy t herea fter ar ising o ut of such contract or tran sacti on . . . shal l be valid, irr ev ocabl e, and enf orceable, save upo n suc h grou nds as exis t at law or in equit y for the re voca tion of any co ntract. 9 U.S.C. § 2 (em phas is ad ded). Nota bly, a contract envelops the ens uing arbitr ation p roceeding by both pro viding (1) the grava men sub ject to arb itration a nd (2) the agree ment to a rbitra te itself. The Supre me C ourt has m aintai ned t he “f unda menta l princi ple t hat arb itrat ion is a ma tter of co ntract, Rent -A- Center, W est, Inc. v. Jackson, 561 U.S. 6 3, 67 (2010) and conse quently “place[s] arb itrat ion agre ements on a n eq ual foot ing w ith other contracts,” Buckeye Check Cashi n g, Inc. v. Carde g na, 54 6 U.S. 44 0, 443 (200 6). Part ies ma y spec ify the sc ope of agre eme nts to arb itrat e, includ ing (1) the matters subje ct to ar bitrat ion, (2) t he rules b y which ar bitra tion is co nducted, and (3) t he partie s bound by the arbitra tion agre eme nt. See AT&T Mobility LLC v. Con cepcion, 562 U.S. 33 3, 3 44 (20 11) (first c iting Mitsubis hi Motor s Corp. v. Soler Ch rysler -

15 Plymou th, In c., 473 U.S. 614, 628 (1985), then Vol t Info. Scie nces, Inc. v. Bd. of Trus tees of Lela nd Stanf ord J unior U niv., 489 U.S. 4 68, 479 (19 89), and f inal ly Stolt - Nie lsen S.A. v. Ani malFee ds In t’ l Corp., 559 U.S. 662, 681 – 82 (201 0)). Delaw are law buttr es ses the req uire ment that an agre ement to arbi trate m ust exist for suc h arbi trat ion to be enforc eabl e. See SBC Interactive, I nc. v. Corp. Med ia P’ rs, 199 7 WL 81008, a t *2 (De l. Ch. 1997) (“Be cause t he o bliga tion or rig ht to contra ct is contra ctual, the sta rting po int of any ana lysis of wh ether a dispu te is arbitr able mus t be the par ties ’ contr act to ar bitra te.”); Gandhi - Kap oor v. H one Cap. LLC, 307 A.3d 328, 356 (Del. Ch. 202 3) (under scorin g the Supr eme C ourt’s thres hold re quire ment of “de termi n[in g] w hether an arbit ration agree ment ex ists i n the fir st pla ce.”) (cit ing Henry Sche in, Inc. v. Archer & W hite Sales, Inc., 586 U.S. 63, 13 9 (2019)). As in t he FAA, t he DUAA re quires “a writte n agreem ent to s ubmi t to arbi tration ” for an enforce able obl igation under the Act to exis t. 10 D el. C. § 5701. The statu te’s text conditi ons the Co urt of Cha ncery’ s jurisdic tion to en force an ar bitra tor’s dec ision o n the exis tence of suc h agree ment. See id. Both Fe deral and Dela ware law em phas izes the contrac tual nature of an arbitr ation a greeme nt a nd the re quir eme nt of a con tract f or any arbitra tion proce edi ng to e xist. Here, howe ver, Spe cialtyC are has faile d to plea d the exi stence of a wr itte n agre eme nt bet ween i tself and MedCo st. Other cou rts c onside ring the ques tion of judic ial re view of the NS A’s IDR pr ocess ha ve admit ted the ab sence of

16 such a greemen t. See, e.g., G uardian Flig ht LLC v. A etna Life Ins. Co., 789 F. Supp. 3d 214, 22 7, (D. Conn. 20 25). 29 Inste ad, Specia ltyCar e points to t he statut ory struc ture of t he NSA, wh ich pro vide s for an IDR proc ess t hat al locate s costs be tween the in surer and t he healthc are provi der. Whi le the NS A prov ides fo r third - party dispu te resol ution bet ween the parties, “ arbitra tion” is n ot a mere coll oquia lism in the D UAA’ s gra nt of jur isdic tion to t he Court of Chance ry over a rbitr ation awa rds. As bot h the FA A an d DUA A evide nce, a writte n agree ment to a rbitrat e is a n ecessar y cond ition for an ar bitrati on to exi st, and the re spectiv e grant s of juri sdic tion t o revie w arbitra tion de cision s in stat e and federa l sta tutory s chem es rel y on a wri tten agree ment, wh ich the partie s lack in this case. Spec ialt yCar e reli es on tw o distr ict co urt decis ions outsi de the NSA c onte xt for the pro posit ion that the Cour t has author ity to co nfirm a “fi nal and b indin g award.” 30 In New Jers ey Bldg. Labo rers’ Sta tewid e Benefi t Funds v. Newar k Bd. of Educat ion, the d efen dan t launche d a colla teral a ttack on th e validit y of an arbi trat ion for la ck of a n extan t arbitra tion agre ement. N ew Jersey Building, 2 013 WL 5 180433, at *2 (D.N.J. Se p. 13, 2013). The C ourt a ffirmed its power to conf irm the a ward 29 I refer to this case a s Aetna throughout the opinion. Although ot her cited cases incl ude Aetna as a party, I will refer to them in sho rt form differen tly. 30 PAB, at 10 (citing GPS of N.J. M.D., P.C. v. Horizon Bl ue Cross & Blue Shield, 2023 WL 5815821, at *10 (D.N.J. Sep. 8, 20 23)).

17 beca use t he par tie s signe d a Collec tive Ba rgain ing Agree ment, which perm itted Trus tees to “ col lect delinqu ent fund s throu gh arbitr ation,” and th e agr eem ent desi gnated a “ permane nt arb itrator to hear an d determi ne collec tion di sputes. Id. at *3. Th e Distric t of New Je rsey furt her conf irmed th at lang uage i n an agree men t “ind icat[ing] the a ward will be final a nd bindi ng implic itly per mits Fe deral c ourt inter vention t o compel com pliance.” Id. (citing T eamste rs - Employ er Lo c. N o. 945 Pensi on Fund v. Acme S anit ation C orp., 963 F. Supp. 3 40, 3 47 (D.N.J. 1997)). Spec ialt yCare put s the cart before the ho r se in relyi ng on New Jersey Buildi ng. While the C ourt rear ticulate d the pri nciple tha t an agre ement to arbitr ate need not expl icit ly inclu de la nguage a greein g tha t “a j udgment o f the co urt shall be inte rested upon the awar d made pur suant to ar bit ration,” the Co urt did not wa ive t he requirem e nt of an ar bitrat ion a gree ment i n the fir st place. 2 013 WL 5 18043 3, at *3 (citi ng 9 U.S.C. § 9). Unlike in New Jer sey Build ing, S pecia ltyCare and Me dCost neit her bargai ned fo r nor signed a n agree ment submi tting to bi nding arbitratio n. No agree ment exi sts for the Co urt to find i mpli ed “aut hority to c onfirm the aw ard.” Id. at *3. Spec ialt yCare fare s no bett er und er its seco nd source of author ity, Chemin ova A/S v. Griff in, L.L.C. 182 F. Sup p. 2d 6 8 (D.D.C. 2 002). T here, the pa rt ies ent ered into bin ding arbitratio n under the Feder al Insecti cide, Fungi cide and Rodent icide

18 Act (“FIFRA”), 31 whic h inc orporat ed the rules of the Fe deral Me diat ion a nd Concil iation Servic e (“FMCS ”). 32 FMCS S ection 37(c) sta tes tha t the rele vant partie s “shal l be deeme d to ha ve con sented that judgm ent upon t he arbitra tion a ward may be enter ed” eith er in fede ral or sta te court. 29 C.F.R. pt. 1440, App. § 37(c). FIFRA permits re gistrant s und er th e statut e to e ngage in “b inding a rbitra tion proce edi ngs,” e ven tho ugh no p rivate contract to a rbi trate exi sts. 7 U.S.C. § 136a(c)(1)(F) (iii). FI FRA furt her prov ides that t he arbitr ator ’s decis ions a re “f inal and co nclusive.” Id. Cheminov a ho lds tha t the terms “ binding ” and “fi nal an d concl usive” i n an arbitr ation sche me deno tes that “a n award wi ll be enforc eable in court. ” 182 F. Su pp. 2d a t 73; see Lan der Co. v. MMP Inv estment s, Inc., 1 07 F. 3d 476, 480 (7th Cir. 19 97) (“T o agree t o bindi ng ar bitratio n is to a gree tha t if you r oppon ent wins t he arbitra tion he ca n obtain j udicial re lief if yo u refuse to c ompl y with t he arbitr ato r’s awa rd.”). While FIFR A depar ts from a tr aditio nal ar bitra tion sche me because th e stat ute’s tex t, not a c ontr act, giv es ris e to arbitra tion, FIFRA an d the NSA ma teria lly diffe r, an d Specia ltyCare c annot re ly on Cheminov a. First, FIF RA pro vides for “arbi tration,” ra ther than a gene ric third - party dispu te resolu tion scheme. Second, 31 7 U.S.C. § 136, et seq. 32 7 U.S.C. § 136a(c)(1)(F)(iii)

19 FIFRA e xplic itly i ncorpora ted FMC S rules, which give ri se t o judicia l review or confir mation of the arb itrator’ s award. Third, t he sta tute empl oyed the terms “bin ding” and “f inal and c onclusi ve” regar ding the a rbi trato r’s decisi on unde r FIFRA. The NSA does s tate that “[a] det ermina tion of a certif ied IDR en tity . . . shal l be bindi ng up on the par ties inv olved,” but follo ws suc h lang uage b y noting t hat the de termina tion “ shall no t be subje ct t o judic ial revie w,” exce pt where FAA Sect ion 10(a)(1) – (4) appl ies. The mere pr esenc e of the t erm “bin ding” cann ot give rise to a n entire a rbitra tion sc heme subj ect to ju dicia l review w hen the pla in te xt of the s tatute r ebu ts suc h readin g. 33 But see GPS of N.J., 2023 WL 5815821, at * 10 (inter pretin g the presenc e of the “ binding” lang uage in t he NSA to ind icate th at “the decis ion is to be ‘fi nal an d binding, ’ and give s the cour t the aut hority t o confirm t he award.”). 34 33 Both F ederal and Delaware law dictate that the Court must read statu tes as a who le and not interpret provision s to create internal co ntradictions. See Coa stal Barge Corp. v. Coastal Zone Indus., 492 A.2d 1242, 1245 (Del. 1985) (“[E]ach part or section [of a statute] should be read in light of every other part or section to produce an h armonious whole.”); Maracich v. Spears, 570 U.S. 48, 68 (2012) (“The provisio ns of a text should be inte rpreted in a way that ren ders them co mpatible, not contradictory. [T] here can be no justificati on for needlessly rendering provisions in conf lict if they can be interpre ted harmoniously.”) (citing A NTONI N S CAL IA & B RYAN A. G ARNER, R EADI NG L AW: T HE I NTERPR ETATI ON OF L EGAL T EXTS 180 (2012)). This is the “Har monious - Reading Canon.” See William N. Eskridge, Jr. & Philip P. Frickey, F oreword: Law as Equilibrium, 1 08 H ARV. L. R EV. 26, 98 (1994) (“Avoid interpreting a provision in a way that would rende r other provis ions of the Act superfluous or unnecessary.”) (inter nal citations omitted). 34 I express my respectfu l disagreement with G.P.S. ’s cons truction of t he NSA infra.

20 Give n the abs ence of a writte n agreem ent bet ween the partie s to a rbitr ate, th e IDR pr ocess i s not an ar bitrat ion and c onseque ntly the Cour t of Cha ncery lac ks juri sdictio n unde r 10 Del. C. § 5102 to c onfirm the IDR e ntity ’s awar d. 35 2. The NS A fails to provid e a priv ate r ight of acti on for confi rmation of IDR a wards. Spec ialt yCare conte nds that the NSA im pliedl y inc orpo rate s Sec tion 9 of the FAA, whic h pro vide s a cause of actio n to the pre vailing party in a n arbitra tion to seek a judg ment con firming the arbit rator ’s awar d. The t ext and struc ture of t he NSA d oes not fa vor S pecialt yCare’s re ading. B oth Fe deral and Delawar e ca nons o f stat utory inter pretati on disfa vor fin ding imp lied priva te right s of action i n compr ehe nsive sc hemes. Such can ons as a pplie d to the NSA i nstruct the Court t o rejec t Special tyCare ’s ar gum ent. a. Statut ory inte nt deter mine s the exist ence of an im plied privat e right of action. Congr ess must c reate pr iva te rig hts of act ion to “enf orce feder al law.” Alexand er v. San doval, 532 U.S. 275, 286 (2001) (cit ing Touche Ross & C o. v. Reding ton, 442 U.S. 56 0, 578 (197 9)). With out an exp ress p rivate righ t of action withi n a statut e, “th e judicia l tas k is to in terpre t the s tatu te Con gress ha s passe d to 35 Even if FAA Section 9 were to apply here, which it does not, the Court of Chancery would lack jurisdiction because the federal st atute provides that def ault jurisdiction lies with the appropriate fe deral district court.

21 deter min e whet her it dis play s an inte nt to creat e not just a pr ivate ri ght but a lso a private reme dy.” Sandoval, 532 U.S. a t 286 (citing Tra nsameri ca Mortg. Adviso rs, Inc. v. Lewis, 444 U.S. 11, 15 (1979)). “St atutory intent is deter minative ” on this point. San doval, 532 U.S. at 286. The Co urt exam ines statu tory t ext t o disc ern whe ther it “ unamb iguously confe r[s] an enforc eable rig ht up on the [sta tute’ s] benef iciaries. ” Gonzag a Univ. v. Doe, 5 36 U.S. 273, 281 (2002) (qu oting Suter v. Ar tist M., 503 U.S. 347, 363 (199 2)). T he inquiry for statut ory inten t “begi ns wit h the text a nd structu re of the stat ute . . . and ends o nce it ha s bec ome clear tha t Congres s did not prov ide a caus e of action.” Sandoval, 53 2 U.S. at 28 8 n.7 (citi ng Nor thwe st Airlines, Inc. v. Transp. Work ers, 45 1 U.S. 77, 94 n.3 1 (1981)). Delaw are has his toric ally fo llowed t he Suprem e Cour ts’s lead i n determ inin g whet her a s tatu te giv es rise t o an implie d private r ight o f action. For severa l year s, the De laware S upreme C ourt a dopted th e multi - fac tor test ar ticulat ed in Cor t v. Ash. 36 See Ma nn v. Op penhe imer & C o., 517 A.2d 105 6, 1064 (Del. 1986) (reciting 36 422 U.S. 66 (1975). In Cort, the Supreme Court enumerated f our factors: (1) whether the plaintiff was “on e of the c lass for whose especial benefit the stat ute was enacted”; (2) whether there is “any indication of legislative intent, explicit or implicit, eithe r to create such remedy or t o deny one”; (3) whether it is “consistent with the underlying purposes o f the legislative sche me to impl y such a remedy for the plaintiff”; and (4) whether t he cause of action is one “traditionally relegat ed to state law . . . so that it would be inappro priate to infer a cause of action based solely on federal law.” Id. at 78 (internal citations omitted). Delaware has consolid ated this analysis i nto three factors. See supra.

22 three Co rt fa ctors: “t he langua ge and focus of the stat ute, the le gisla tive hist ory, and [its] u nderly ing pur poses.”) (in ternal cit ations om itted). Follo wing th e decisi on in Sandov al, Delawar e courts have id entifie d the second Cort factor, stat utory in tent, as “u sually d isposit ive unde r co ntempora ry ana lysis.” Reylek v. Albence, 2023 WL 88500 74, at *4 (Del. Sup er. Dec. 21, 2023). 37 In Sandoval, the S upr eme Co urt held tha t Title VI of the Civ il Ri ghts Act lacke d an impli ed privat e right of actio n to enforc e regulat ions prom ulgate d under Sect ion 602. 532 U.S. at 2 93. There, pla intiffs sued the Ala bama De partment of Publi c Safety for viola tion o f Titl e VI for ado pting a policy administ ering d river’s licen se examina tions only in En glish. Id. at 278. The DOJ a dopte d a re gula tion “for biddi ng [Dep artm ent of Tr anspor tati on] fund ing r ecip ients to ‘ utilize criteria or methods of a dministra tion wh ich have the e ffect o f subje cting individu als to 37 The Delaw are Suprem e Court has not ye t explicitly adopted the Sandoval stan dard, but lower courts have predicted such adoptio n to be likely. See Rays Plumbing & Heati ng Serv., Inc. v. Stover Homes, L.L.C., 2011 WL 3329384, at *2 (Del. S up er. July 26, 2011) (“Delaware has not adopted th e [Sandoval ] standard yet; however, a Delaware C ourt of Chancery decision fou nd that the Dela ware Supreme C ourt will likely embrace the newer federal standard at the first opportunity because State law in thi s area has tradition ally tracked Federal law.”) (citing O’Nei ll v. Town of Middleto wn, 2006 W L 20507, at *19 (Del. Ch. Jan. 18, 2006)). In O’Neill, Vice Ch ancellor Noble f ocused on th e second Cort factor following the Sandov al decision, noting t hat “the Cou rt should also address the United States Supreme Court’ s current implied p rivate right of action d octrine because Delaware courts have historica lly hewn closely to the an alyses of the Un ited St ates Supreme Court in this context.” 2006 WL 205071, at *19 (ci ting Lock v. Shreppler, 426 A.2d 856, 864 (Del. Super. 1981) (sup erseded by statute)).

23 discr iminat ion be caus e of their rac e, c olor, or nati onal orig in . . . .’” Id. (quoti ng 28 C.F.R. § 42.10 4(b)(2) (2000) (effect uating the ant idisc rim ination provisio n of Title VI, Sect ion 601)). While Secti on 601 pro hibit ed discrim ination on the basis of race or nat ionalit y, and Se ctio n 602 pe rmi tted the D OJ to pr omulga te regula tions, Ti tle VI lac ked a prov ision pro viding a pr iva te righ t of action for viola tion of suc h regul ations. Sandov al, 532 U. S. a t 278 – 79. Instead, S ection 6 02 provid ed an alter nativ e means of enforcemen t — per mitting agencie s to “te rmin at[e] f unding to the ‘pa rtic ular prog ram, or par t there of,’ th at has vi olated the regulat ion . .. .” Id. at 289 (quoting 4 2 U.S.C. § 2000d –1). Sandov al ’s inqu iry begins a nd en ds “wit h the tex t and str uctu re of [th e Statu te.” Sec tion 60 2 lacked t he require d “right s - creati ng” lang uage t hat woul d perm it the Court to infer a priva te right o f action. See, e.g., Canno n v. Univ. of Chicago, 441 U.S. 6 77, 690 n. 13 (1979) (“ Not su rprisi ngly, the right - or dut y - creat ing langua ge of the sta tute ha s general ly been the mos t acc urate in dicato r of the propr iety of i mpli catio n of a cause of ac tion.”). Inste ad, Sec tion 602 c onferre d power on the D OJ to pr omulg ate re gula tion s enacti ng Sect ion 601’ s an ti - discr iminat ion r egim e. See S andov al, 532 U.S. at 189 (“Far from display ing cong ressiona l intent to create ne w rights, § 602 limits agen cies to ‘ ef fec tuat [i ng] ’ righ ts alre ad y crea ted by § 6 01.”) (em phasis a dde d).

24 Furthe r, the Cou rt disfa vored imp lying a pri vate rig ht of acti on where t he partie s benefi ting fro m the sta tute are “twice rem oved” fr om the sta tute’s foc us. Id. For e xampl e, Sectio n 601 see ks to b enefit persons s ubject t o dis criminat ion on th e basis of race or nation al origin. Section 602, howe ver, sp eaks to a federal a gency’s auth orit y to effec tua te reg ulation s that im plemen t Sec tion 6 01. Suc h atte nuation is hi ghl y probati ve of Co ngres s’s intent to no t provide an impli ed private r ight of action. Cf. C a nnon, 441 U. S. at 6 90 – 91 (buttr essing it s finding of an implie d priv ate righ t of ac tion where the statute “expr essly ide ntifie[d] the cla ss Congr ess inte nde d to benef it”). Final ly, the pre sence of an e xplicit re med y in a statute ’s text c onfirm s that Congr ess did not inte nd to impl ied ly crea te a distinc t remedy. Sect ion 602 permits the g overnme nt to enf orce its reg ulations by rem oving f unding w here a progra m viola tes Title VI. S andoval, 53 2 U.S. at 290 (no ting t hat “t hese e laborate res tricti ons on age ncy enforc ement . . . tend to contra dict a congr ession al intent to c reate priva tely enfo rceable rights . .. .”). Yet anothe r fundame ntal can on of stat utor y cons truct ion states th at “where a sta tute expr essl y prov ides a pa rticu lar remedy or remed ies, a cour t must be char y of readi ng others i nto it.” Tran sameric a Mortg. Advis ors, Inc. (TAMA) v. Lewis, 444 U.S. 1 1, 19 (1979); accord Mid dlesex Cty. Sewe rage A uth. v. Nat ’ l Sea Cl ammers A ss’n, 453 U.S. 1, 19 – 20 (1 981) (for eclosing an expr ess Sec tion 198 3 remed y wher e the rele vant fed eral sta tute’s “r emedia l

25 devic es” wer e suffic ient ly c ompre hensive, indica ting C ongress’ s inte nt to preclude other, applica ble remedies). M oreo ver, as an e xerci se of this Court’ s pru dence, “[t] he jud iciar y may not . .. fashi on ne w reme dies tha t migh t upse t caref ully consi dered le gislat ive progr ams” wher e Cong ress has “en acted a compr ehens ive legis lativ e schem e includi ng an integr ated s yste m of pro cedure s for enfor cem ent. ” Nort hwest Airline s, Inc. v. Transp ort Wo rkers U nion o f Am., AFL -CIO, 451 U.S. 77, 97 (1 981). Fortu itously, se veral federal District C ourts hav e ruled o n the very lega l ques tion p resente d by Spec ialtyCa re. 38 Regretta bly, su ch opinio ns are div ided. One line of d ecisio ns he ws close ly to the s trict tex tua lism of Sandoval, decli ning to find an impl ied priva te ri ght of ac tion i n the NSA. The other l ine r epr is es a m ore capa ciou s appr oach to th e stat ute, iden tifying r ights - crea ting lan guage with in the NSA an d permit ting an im plied priva te right of action. In accor da nce wi th princi ples of Fe dera l and Delaw are statu tory inte rpre tation, I adopt the former appr oach. MedC ost relie s on a rec ent decision out of the Middl e Distr ict of Flori da, rejec ting any im plied pr ivat e righ t of actio n under the NSA. Med - Tran s Corp. v. Capi tal Healt h Plan, Inc., 700 F. Supp. 3d 1076, 1082 (M.D. Fla. 2023). There, the Court r ejec ted tw o the ories: (1) that the NS A incorpor ated th e FAA’s pr ocedura l 38 The parties did not i dentify, and I a m unaware of an y state cour ts that have iss ued decisions on the matter.

26 rules, and (2) tha t the FAA pre sumptiv ely appl ies to t he NSA’ s IDR pro cess. Se e id. at 1082 – 84. M ed - Tra ns rejec ts the fir st theor y becau se the NSA i ncorpo rated only S ection 10 o f the FA A. A pplyi ng the “c ardina l can on” that “cou rts pr esume that a le gisla ture sa ys in a stat ute what it m eans and mea ns in a stat ute wha t it says there,” the Court co nclu ded th at inc lusio n of one pro vision of t he FAA t o the exclu sion of a ll othe rs mea nt that t he provisio ns of the F AA permi tting a part y to challe nge an aw ard do n ot ap ply un der the NS A. Id. at 1083 (ci ting Vill arreal v. R.J. R eynold s To bacc o Co., 839 F.3d 95 8, 969 (11th C ir. 2016)). As f or the se co nd theor y, M ed - Trans rejec ted that the FA A “pre sum ptive ly” a pplied to NS A IDR deter min atio ns bec ause IDR is not an arbi tratio n. See id. a t 10 83 – 84 (not ing t hat the FAA re quir es an a greemen t, i.e., c ontract, to arbitr ate); see also su pra § II.A.1. One y ear fol lowing th e Med - Trans dec ision, the North ern Di strict o f Texa s adop ted a sim ilar rati onale in dec lining to fin d an im plied pri vate r ight of actio n in the NS A. Guardian Flig ht L LC v. H ealth Care Serv. Corp., 735 F. Supp. 3d 742 (N.D. T ex. 2024), af f’d, 140 F.4 th 271 (5th C ir. 2025). Guardian Flig ht LL C relied on Sa ndoval ’s logic in noti ng that t he NSA la cks lang uage “establ ishing th at Congr ess inte nde d to c reate a r emedy fo r out - of - net work provide rs.” Id. at 750 (stati ng a Sa ndova l reme dy de note s a “pr oced ural cause of ac tion, not the sub stan tive remed y.”) (em pha sis in or igina l) (citin g Dia gnostic Affili ates o f N e. Houst on, LLC

27 v. Aetna, Inc., 654 F. Supp. 3d 595, 610 (S.D. Tex. 2 023)). 39 Not only does th e NSA decli ne to inc orp orate FAA Sec tion 9, but it also la cks “a ny fee - shifting provis ions or any o ther lan guage sugge sting th at Cong ress in tended to c onfer a private cau se of action to heal thca re provid ers.” Gu ardian Flight LLC, 735 F. Supp. 3d a t 750. 40 In the F ifth C ircuit’ s affirman ce of the Di strict Co urt decis ion, the court n oted the hea vy burd en pl aced upon p laintiff s to “over come [the] presumpt ion” tha t Congr ess “did n ot int end to crea te any p rivate ca use of a cti on. ” 140 F.4th a t 275 (citi ng Sig mon v. Southw est Airli nes C o., 110 F.3d 12 00, 1205 (5t h Cir. 199 7)). Th e Circ uit Co urt discla imed any distinct ion betwe en judi cial en forcem ent of an IDR awar d an d judi cial re view of such an a ward. 140 F. 4th at 27 5 (“The term ‘jud icial review ’ is br oad enou gh to in clud e a c ourt’s order to e nforce a n IDR a ward. ”); s ee 39 Guardian Flight rejec ted two argume nts that the N SA created ri ghts (and impliedly a remedy). The NS A sta tes that IDR determinat ions “shall be bin ding,” 42 U.S.C. § 300gg - 111(c)(5)(E)(i)(I), and requires pay ment within thirty days, id. § 300gg - 112(b)(6). “[W]hen read together, [these provis ions] do not suggest that Congress inten ded to crea te a procedural mechanism for provid ers to convert IDR a wards to final judg ments.” Guardian Flight LLC, 735 F. Supp. 3d a t 751. 40 Guardian Flight juxtaposes the NSA with Ti tle IX of the Civil Rig hts Act, which the Supreme Court determi ned to include an impli ed private right of acti on. 735 F. Supp. 3d at 750; s ee Cannon v. Univ. of Chicago, 441 U.S. 677 (1979). Cann on relied on Title IX’s attorneys’ fee- shifting provisions to infer the existence o f a private ri ght of action, thereby holding t he statute’s te xt indicate d that Congr ess’s intent to create a private cause of action. See i d. at 699 – 700. The NSA l acks such lan guage. Mo reover, Sandov al ’s rigid skepti cism departs from the more pliable Cort v. A sh factor- based approach. S ee Anthony J. Be llia Jr., Justice Sc alia, Implied Rights of A ction, and Historic al Practice, 92 N OTR E D AME L. R EV. 2077, 2086–87 (2017).

28 Concre te Pip e & Prod ucts of Calif ornia v. Constru ctions Labore rs Pen sion T rust for S outhern Calif ornia, 508 U.S. 6 02, 611 (199 3) (inter pret ing an ERIS A provis ion that “ provide s for j udicial r evie w of the arb itrator’ s decisi on by an ac tion in the distr ict cour t to e nfor ce, vacate or modif y the awa rd.”). Spec ialt yCar e reli es on tw o deci sions arr iving at the o pposite c onclusio n. The most su bstanti ve is Guardia n Flight LLC v. Ae tna Lif e Insuran ce Co., 789 F. Supp. 3d 214 (D. Co nn. 20 25). 41 There, the Cour t rejecte d the argum ent tha t the NS A’s failur e to inco rporate FAA Sect ion 9 pr oscribes judicia l rev iew. Inst ead, beca use IDR de term ina tions are autom atical ly bind ing and tr igge r imm edia te paymen t obliga tions, “ there is no reaso n for the NS A to refe ren ce” Sec tion 9. Id. at 227. 42 Aet na fur ther read s the NSA’ s proscri ption on judicia l review a s only b arring vaca tur o f an I DR de terminat ion for re asons n ot enumer ated with in FAA S ection 10(a). Id. at 22 7 (“Cour ts ca nnot vaca te or e nter tain colla teral a ttacks on these awards — e ven those tha t would fa ll within th e FAA’s na rrow scope of re vie w.”). But, p er Aetna, the N SA’s bind ing lan guage an d Timing of Paym ent pro visio ns do 41 See PAB, 9 –15. 42 Even if I were to adopt Aetna ’s log ic, the law would still compel me to dismiss t his case for want of subject matter juri sdiction. Aetna disti nguishes arb itrations a nd the IDR process with great care. See 789 F. Supp. 3d at 227. As e xplained su pra, this Court lacks jurisdiction to enforce a third - party d ispute resolution ou tside the arb itration context. See 10 Del. C. § 5702(a).

29 compr ise clear r ights - c reat ing la ngua ge, whic h in tur n reflec ts “‘con gression al inte nt to c reate bo th a right and a remedy ’ for the indiv iduals t o whom paym ent is d ue.” Id. at 22 8 (em pha sis in origina l) (citi ng Maine Cmt y. Healt h Opti ons v. Unit ed State s, 590 U.S. 296, 324 (2 020)). Pur suant t o this logic, Aet na interpr ets the NS A to per mit judi cial act ion to e nforce the a wards (c onfirmi ng thei r “bindin g” natu re) and to prosc ribe ju dic ial in terfe rence wi th their f ina lity, e xcepti ng the FAA S ect ion 10 (a) co ntext. Final ly, A etn a con tends t hat fa ilure t o permit an im plied priva te right of actio n would “ ren der IDR a wards mea ning less” and cr eate “st range as ymmetr ies.” 789 F. Supp. 3d a t 228. After a ll, a co urt co uld inter vene on ly in c ases of fr aud or corr uptio n. Ae tna sugges ts that abs ent a pr ivate ri ght of acti on, legi tima te awards lack the arti llery su ppor t of jud icia l enforce ment, but c our ts can easily in terve ne to inva lidate the m. Eve n thou gh A etna ackno wledge s the abi lity of a genci es to inter vene un der the NSA’s tex t, “[the se] sta tutory pr ovisio ns . . . do no t empower agenc ies to enf orce ind ividual I DR awar ds or to ho ld health plans and insurer s acco unta ble f or untime ly payme nts. Id. at 229. Spec ialt yCare a lso re lies on G PS of New Jersey, M. D., PC v. Hor izon Blue Cros s & Blue Shie ld, 202 3 WL 5815 821 (D.N. J. Sep. 8, 20 23). 43 There, the C ourt 43 See PAB, 10.

30 hear d cro ss motio ns to vaca te and t o confir m the IDR determ ina tion. Notabl y, the GPS C ourt did n ot conside r whether the I DR proce ss differs from arbitrati on. S ee id. at * 10 (“[U] nless the arb itration award is vacate d pur suan t to [FAA] Sec tion 1 0 or mod ified or c orrecte d under Sec tion 11 .. . the awar d ‘must’ be c onfirme d.”) (quo ting 9 U.S.C. § 9). Afte r conc luding that defe ndants d id not me et the F AA Sect ion 10(a) standar d to vacate the IDR deter minatio n, GPS held th at the court “must ” conf irm the awar d, relyi ng on the “final a nd bindi ng” rat ionale f or co urt inter vention. Id. at *10 (quot ing New J ersey B uildin gs Labo rers’ St atewid e Benef it Funds v. Newark Bd. of Educat ion, 201 3 WL 5180433, at *3 (D.N.J. 1997) (“la ngua ge [in 9 U. S.C. § 9] tha t indic ates the awa rd will be fi nal and bind ing impl icitly per mi ts Fede ral c ourt in terven tion to c ompel c omplia nce.”)). Plain tiff cann ot both ar gue tha t (1) IDR determ inatio ns are self - e nforc ing, unlike arb itratio ns, and thus have no ne ed for Section 9’s confirm ation provisi ons (Aet na), and (2) t he Court “m ust” conf irm the dete rmi nation be cau se it is final a nd bindin g (GPS). See T.V. Sesha n M.D., P. C. v. Blue Cro ss Blue Sh ield Assoc., 2025 WL 349 6382 (rej ecti ng a compar able a rg ument where the p laintif f re lied on bo th GPS an d Aetna); see also Me d - Trans Corp., 700 F. Su pp. 3d a t 1084 (stating t hat GPS “ had no n eed to gra pple with the broa der appl icabi lity of th e FAA to t he NSA ” beca use t he par ties as sumed Sec tion 9’s appl icab ility).

31 Not onl y is Plain tiff’ s positi on contra dictory, but even ta ken in th e alternat ive, the NS A’s tex t vitia tes nei ther argum ent. Unde r a l ine of pre cede nt stretc hing fr om Canno n to San doval, “An implie d righ t of actio n is inc ongruou s with s uch a deta iled stat utory sche me, in which jud icial revie w is limited t o specific insta nces. ” FHMC LLC v. Blue Cr oss and Blue Shie ld of Ari zona Inc., 2024 WL 1461 989, at * 3 (D. Ariz. Apr. 4, 202 4). An alte rna te enforc eme nt sc heme exis ts unde r the NSA and feder al agenc ies app ear pr epared t o act und er the s tatute. S ee, e.g., Ellen Montz, Depar tment of Heal th & Human Se rvic es: Cente rs for M edicare & Medicai d Serv ices (Feb. 2 3, 2022), https://www.cms.gov /file s/ docum ent/caa - enforcement - letters - ar izona.p df (“CMS will e nfor ce the outc ome of the fede ral inde pen dent dispu te resol ution pr ocess for such cas es in Ariz ona.”). As in Sando val, t he statute conta ins a regu latory enf orceme nt mechani sm, whic h mea ns tha t Con gress cons idere d how to re dress violati ons o f the te xt’s re quire ment. Fu rther more, the NSA in corpora tes a remed y (FAA Sec tion 10) to t he exclu sion of ot hers. Spec ialt yCare’s ar gument th at fai lure t o recognize an imp lied priva te right of ac tion would result in the N SA’s unenf orce abi lity fai ls for one sim ple re aso n: Con gres s incl uded remed ial prov isions. S pecia ltyCare ’s di ssat isfac tion wi th the stat utory schem e ca nnot c omp el the C our t to cr aft a n addit ional remedy by judi cial f iat. Accor dingly, I must dism iss Cou nts I a nd II.

32 B. Special tyC are’s c auses of acti on in the alt ern ative t o the NS A fail to stat e a c laim. P leading in the al ternat ive to its NSA claims, Spec ialtyCa re br ings a bundle of lega l and eq uitable claim s: Acco unt Sta ted (C ount II I), Quan tum Mer uit (Count IV), and U njust Enri chment (C ount V). Havin g reject ed the NSA claim s, I must now tur n to Cou nts III –V to determ ine whe ther S pecia ltyCar e’s pleading overcom es MedC ost’s 12(b)(6) cha lle nge. It doe s not an d Counts I II – V a re di smisse d. 1. Delaware disf avors Acc ounts Sta ted Claim s and no su ch accou nt e xist s between the partie s. Coun t III is dism issed. T o esta blish a claim for a cco unt state d, a plain tiff mus t allege and prove thr ee essen tial eleme nts: (1) an ac count exi sted be twee n the part ies; (2) the defend ant state d or admitt ed to owing a s pecific sum on acc ount to t he plaint iff; and (3) t he defe ndan t made this admissi on aft er the ori ginal acc ount or de bt wa s cre ated. Spare bank 1 SR - Bank ASA v. Wi lhelm Maass GMBH, 20 19 WL 6033 950, at *6 (Del. Super. Nov. 5, 2019). When a par ty brings a claim for account state d, i t can o nly reco ver by sho wing both the acc ount a nd a n unqua lified as sent of defen dant to its corre ctness. Shea v. Kerr, 40 A. 24 1 (Del. Super. 1898); s ee Spa rebank, 2019 WL 60339 50, at *7 (“ [T he] c ompl ain t must prov ide fa cts that t he d efen dant sta ted or admit ted to owin g a specifi c sum on the a cco unt to the pla intiff. ”) (inter nal citat ions omit ted). Acco unt sta ted is a le gal theor y where one pa rty’s “ stating ” of the ac count compr ises con siderat ion for the prom ise to pa y, ther eb y crea ting a new c ontr ac t

33 “cha ng[i ng] the cha racter of the origina l debt.” Balie zewski v. Put zcus, 132 A.217, 218 (Del. Super. 1926) (ci ting Cha mbers v. Fen nem ore’s Adm’r, 4 Del. 368, 3 71 (Del. Super. 1846)). Spec ialt yCar e’s ple adin g for acc ount sta ted does no t state a c lai m. Notab ly, the plea ding fai ls to plausi bly allege that Me dCo st admi tted to owin g any de bt to Spec ialt yCar e. S pecialt yCare inf ers suc h an acc ount by the f act that it “render ed OON ser vices and ite ms” to MedCo st’s membe rs and tha t MedC ost was “o bligate d to pr ovide co verage f or” S pecia ltyCar e’s s ervices. 44 SpecialtyCar e further a vers th at MedC ost’s “kn owle dge, a cceptance, and rete ntion ” of such benefits co nferre d compr ises acknowledgm ent of a de bt owed. 45 Finally, Special tyCare refere nces t he NSA pr ocedure of (1) submitti ng claim s to MedCo st and (2) enteri ng int o the IDR deter min atio n, wh ich ultima tely com prises the accoun t. The ple aded fac ts and contex t of the NSA c ontra dict Speci altyCa re’s theor ies. First, even if Me dCost ac cept ed and rec eive d a benefit f rom S pecia ltyC are’ s servic es, such al legati ons do n ot adequ atel y plead the exis tence of an ac count. Our law co ntempla tes an expr ess agree men t “subse quen t to the cre atio n of the debt” stat ing that the de btor owes a certa in sum. See Chry sler Corp. v. Airtemp C orp., 426 44 Compl., ¶¶ 42, 44. 45 Id., ¶¶ 48, 50.

34 A.2d 8 45, 849 (Del. S uper. 1980). In addit ion to a su bsequen t agree ment, Spec ialt yCar e must “ provid e fact s that the defendan t stated or a dmitte d to owing a specif ic sum on the acco unt to the pl aint iff.” Citiba nk (S o uth Dak ota) N. A. v. Santia go, 2012 W L 592 873, at *2 (Del. C.P. Feb. 23, 20 12). The p leadings la ck any allega tion of th e exist ence of a subs eque nt agreem ent or M edCo st’s admis sion of a debt ow ed. Seco nd, the NS A contex t specifica lly reb uts the pos sibilit y of an ac count state d claim. The NS A redress ed pro blems arising f rom OON claims. Because t his dispu te arise s from th e previo us IDR deter minati on, Specia ltyCare doe s not opera te withi n MedC ost’s pref erred provi der networ k an d that no acc ount exi sted bet ween the par ties. 46 Becau se Specia ltyCar e has f aile d to reas onably pl ead th e elemen ts of a n acco unt sta ted clai m, Coun t III i s dism issed. 46 See Compl. ¶ 8; DOB, at 13. The N SA ope rates in the c ontext wh ere no contractual relationship existed between the insurer and medical provider. It is difficult to conceive how the NSA could apply in a context th at gives rise to an accou nt stated claim. While MedCost argues that it was never involved in the IDR proceedings, its support from this claim lies beyond the complaint and inc orporated exhibits and thus cannot be considere d at the Motion to Dismiss stage. See DOB, 13. That said, I decline to h old that participation in an IDR proceeding c onstitutes adequat e pleading of “a greement” or “acknowledgement” of a debt sufficient for an account stated clai m.

35 2. Because Med C ost as an insure r received no benef it from Specia ltyCar e’s ’s ser vices, the claim s for qu antum mer uit and unjust enrichment are dismissed. Both of Specia ltyC are’s eq uitable claims, quantu m meruit and unj ust enric hme nt, r equir e one par ty to confe r a benefit t o anot her. A par ty may r ecov er under a the ory of q uantum mer uit whe re (1) “the party performe d the serv ices wit h the ex pectat ion that the reci pient wo uld pay f or them”; and (2) “ the rec ipient s houl d have known t hat the part y expect ed to b e paid.” Endow ment Rsc h. Gp., LLC v. Wildc at Ventu re P ’ rs, LLC, 2021 WL 84104 9, at *13 (De l. Ch. Mar. 5, 202 1). A claim lies for unju st enrichm ent whe re the c laima nt plea ds “(1) an enr ichment, (2) an imp overis hmen t, (3) a rela tion be tween the enr ichmen t and imp overish ment, (4) the ab sence of just ificatio n, and (5) the a bsence o f a remed y provided by law.” Id. (citi ng Nemec v. Shra d er, 991 A.3d 112 0, 1 130 (Del. 2010)). 47 The par ties’ briefs focus on whe ther “provi ding ser vices to an insure d. . . benef it[s] the i nsurer in a wa y that sus tain s a qua si - contrac t claim. ” 48 MedCos t relie s 47 While the briefing ref ers to the two causes o f action as quasi - contr act claims, the y a re distinct. Quantum meruit is “a principle of r estitution arising from a cause of action in quasi- contract,” where as unjust enr ichment i s a cause o f action “us ually but not always equitable, based on an unjustified enrichment of one party and resulting impoveris hment of another party, in the absence of a remed y at law.” Hynansk y v. 1492 Hosp. G p., 2007 WL 2319191, at *2 (Del. Super. Aug. 15, 2007) (citing Jackson Nat’l Life Ins. Co. v. Kennedy, 741 A.2d 37 7, 393 (Del. Ch. 1 999)). 48 DOB, 15. MedCo st also argue d that SpecialtyCare p rovided serv ices to MBS, not MedCost. Such argument relies on facts beyond the pleadings, and I decline to entertain this line of argume nt at the Motion to Di smiss stage. See PAB, 20.

36 on a ser ies of ca ses hol ding t hat an i nsure r does not r ece ive a benefit w here servic es are “r endere d to an ins ured, because th ose servi ces are n’t dir ected to or for the benef it of t he ins urer. ” Angelin a Emer gen cy Med. Ass ocs. P A v. Health C are Servs. Corp., 506 F. Supp. 3d 4 25, 53 2 (N.D. T ex. 2020); see, e.g., Plas tic S urgery Ctr., P.A. v. Cigna Health & Life Ins. Co., 2019 WL 19162 05, at *8 (D.N. J. Apr. 30, 2019) (“Distr ict court s have cons iste ntly di smissed unjus t enrich ment claim s under substa ntial ly sim ilar c ircum sta nces, reasoni ng tha t, if an ything, th e benefit is d erive d sole ly by the i nsure d party.”) (em phasis added). In re spons e, Specia ltyCare cites a recen t line of case s ho lding th at an unjust enric hme nt claim may lie against an insur er bec ause “the be nefit c onferr ed . . . is not the pro vision of t he health care serv ice per se, but r ather the di scharge of th e obliga tion.” Pla stic Sur gery Ctr., P.A. v. Aetna Life Ins. Co., 967 F.3d 218, 240 (3d Cir. 2 020); see Med Well, L LC v. Cign a Corp., 2021 WL 20 10582, at *4 – 5 (D. N.J. May 19 202 1) (app lying Plastic S urge ry). Neit her party br iefed De lawar e law o n whether an ins urer receives a benefit when th e insure d is pr ovide d health c are se rvice s, likel y becaus e no Dela ware case is squa rely on poi nt. Thus, I am for ced to look at aut hori ty outs ide of Delawa re to cons ider i ts pers uasi venes s. I firs t note tha t Plastic Surge ry ’s perm issi veness i n permi tting qu asi - con tract clai ms again st insu rers in this context appears to be t he minor ity rule. See, e. g., Abir a Med. Lab ’y s LLC v. Blue Cro ss Blue Shie ld of Ariz.

37 Inc., 202 5 WL 10 00739, a t *9 (D. Ariz. Apr. 3, 2 025) (coll ecting c ases de clining to recognize a ben efit conferred t o an insurer because o f a disc harged oblig ation to pay medic al ex penses). More over, Plas tic Surgery, (1) applie d New Jerse y Law, (2) invol ved espec ial dutie s imposed o n the insure d, and (3) re ckoned with ERI SA pree mption. I declin e to depa rt from the ma jori ty rule to hold tha t payment of an insur ed’s me dical ex penses c onfer s a be nefit on an i nsurer, espec ial ly whe re a compr ehe nsive fed eral stat utory pro gram creates a pr oce dure with prescr ibed remed ies in th is specif ic conte xt. Becau se Specia ltyCar e faile d to plead th at MedC ost rec ei ved an “e nrichme nt” by virt ue of insure d parties rec eiving ou t of networ k med ical cover age (unjust enric hme nt) or that MedCost s hould ha ve kn own tha t Specia ltyCare w ould bea r the costs of these s ervice s (qua ntum meru it), Cou nts I V and V ar e dismi ssed. Given t he nove l, undeve lope d le gal theor ies a t issue her e, howe ver, I dism iss the se coun ts witho ut prejud ice. 49 III. CONC LUSION Counts I and II are DISMISSED with prejud ice becaus e this C ourt lac ks subje ct ma tter ju risdicti on and, in t he alterna tive, Spec ialtyCar e has fai led to state a claim for t his Cour t’s conf irmatio n or enfo rcement of IDR proc eeding s. Count II I 49 Plaintiff may well wi sh to bring these claims with targeted plea ding and more developed briefing sufficient to ad vance an issue of fir st impression in Delaware.

38 is D ISMISSED with prejud ice beca use Spe cial tyCare fa iled to sta te a cla im for acco unt st ated. C ount s IV and V are DISMISSED wi thout prejudic e. This is my final r ep ort, a nd exce ption s may be fi led unde r Cour t of Cha ncery R ule 144.