Insurer Highmark Sues Federal Government for ACA Dollars

June 2, 2016


Pittsburgh based insurer Highmark alleges that it is owed nearly $223 million under the ACA. The lawsuit claims that the US government violated the ACA’s “risk corridor payment obligations,” a program created to help insurers cover potential losses from issuing policies on state Exchanges. Highmark’s suit, requesting the full risk corridor payments for 2014, sites the language of the ACA and Exchange Marketplace contractual language. The alleged underpayment comes after HHS had previously announced that insurers may initially receive only 12.6% of the money they claimed under the risk-corridor program for 2014.

The suit from Highmark, an insurer heavily involved in the ACA health-insurance marketplaces of the northeast, follows the class-action suit filed by Health Republic Insurance Company of Oregon, which claimed that insurance companies are owed a collective $5 billion based on the federal government’s failure to make annual risk corridor payments. It is likely that similar suits for missed risk-corridor payments will follow.

Contributed by Jess LeDonne

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