The National Law Journal by Mike Scarcella May 08, 2019
Lawyers for health insurers contend the U.S. government is liable for billions of dollars under a cost-reimbursement program tied to the Affordable Care Act. Kirkland's Paul Clement, lead counsel for one insurer, calls the government's actions a "bait-and-switch of staggering dimensions."Health insurance providers are not entitled to billions of dollars in payments from the federal government covering losses that arose from their participation in the Affordable Care Act’s online marketplaces, the U.S. Justice Department told the U.S. Supreme Court on Wednesday.
The Justice Department is asking the Supreme Court to reject challenges from providers claiming the U.S. government is on the hook for more than $12.3 billion in so-called “risk corridor†payments. Any obligation to make those payments, the government told the justices in a new filing, was voided when Congress “expressly prohibited†the Health and Human Services Department from continuing to make payments using certain funds.
The Justice Department’s brief asked the Supreme Court to uphold a divided ruling from the U.S. Court of Appeals for the Federal Circuit. The Washington-based appeals court ruled 9-2 in support of the government last year.
Participating in the Affordable Care Act’s exchanges presented business risks for health insurers, and the risk corridors program, operating from 2014 to 2016, was designed to use cash from thriving health plans to reimburse other health providers whose costs exceeded premiums. Numerous suits seeking money damages were filed in the Washington-based U.S. Court of Federal Claims, generating a substantial amount of litigation and uncertainty as judges there divided over whether the government had broken its promises.
“Like numerous other insurers, petitioners responded exactly as Congress intended, participating in the exchanges and charging lower premiums than they would have absent the government’s commitment to share some of the risk,†lawyers for Oregon-based Moda Health Plan Inc. said in their petition in February at the Supreme Court.
More:
https://www.law.com/nationallawjournal/2019/05/08/justice-dept-spurns-12b-bait-and-switch-claims-in-scotus-health-care-case/
