HealthNow New York, a Buffalo-based insurer and umbrella company of BlueCross BlueShield of Western New York in Buffalo, sued the federal government claiming it is owed more than $38.7 million under the ACA's risk corridors program, New York Law Journal reports.
The temporary risk corridors program sought to level the financial playing field for payers during the first three years of the ACA's enactment. Under the program, HHS collected payments from insurers with lower-than-expected claims on the health insurance exchanges and made payments to insurers with higher-than-expected claims.
HealthNow alleges the government breached "its risk corridor payment obligation under an implied in-fact contract" by paying the insurer less risk corridors payments than it claims it is owed, the report states. The lawsuit, filed Aug. 11 in the U.S. Court of Federal Claims in Washington, D.C., argues while CMS conceded to owing HealthNow $9.6 million under the program in 2015, it owes another $29.1 million to the insurer for 2016.
For the full report, click here.