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.
More articles on payer issues:
Iowa submits final request to stabilize state’s individual marketplace
Anthem expands discretionary ED coverage policy to Indiana
Number of counties at risk of having no ACA exchange insurer drops to 1
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.