Here are five observations:
1. In their suits, New Mexico Health Connections and Minuteman Health of Massachusetts claim the program has an inaccurate formulate that favors large insurers.
2. Maryland’s Evergreen Health was the first co-op to file a suit, with a federal judge denying the co-ops request earlier this week to delay payment while officials evaluate the risk-corridor program.
3. A CMS spokesperson said the agency is working to identify and amend the program’s deficiencies and added, “We continue to work with companies and states to refine the program so that risk adjustment works for both insurance companies and consumers shopping for affordable coverage.”
4. However, many co-ops argue they have already suffered the losses and therefore should not have to pay large funds to the federal government.
5. Of the ACA’s original 23 co-ops, only seven remain viable. Several ACA co-ops have closed midway through this year, leaving many patients to face escalated out-of-pocket costs and find new physicians.
More articles on coding & billing:
Humana brings Ameritox to court for false & fraudulent claims; seeks to recover millions: 5 key insights
Escalating drug prices will hurt Medicare’s catastrophic prescription coverage: 5 things to know
The payer megamerger deals may soon unravel, leaving the ACA exchanges to suffer another blow: 5 points
