Dentons’ Health Care and Commercial Litigation teams recently secured a significant victory for longstanding client Milliman, Inc. (Milliman), the largest actuarial firm in the United States, when the U.S. District Court for the Western District of Virginia dismissed with prejudice relators’ claims in U.S. ex rel. Dixon v. Sentara Health Plans, a federal False Claims Act (FCA) case that sought to challenge Affordable Care Act (ACA) premium rates filed in Virgina. The decision, which was issued on July 31, 2026, affects every insurer submitting rates in connection with government health care programs, as well as the actuaries assisting with the development of those rates.
In 2017, Optima Health Plan (Optima), a subsidiary of Sentara Health, worked with Milliman, its external actuarial consultant, to set proposed 2018 ACA premium rates for individual health plans in Virginia. The market that year was in flux: the incoming administration was threatening to upend the ACA, and in August 2017 Optima’s leading competitor, Anthem, withdrew from Virginia’s individual marketplace, leaving Optima as the only insurer in parts of the state. Optima submitted its proposed rates to Virginia’s Bureau of Insurance (BOI) and to the Centers for Medicare & Medicaid Services (CMS) for review and approval.
Three Virginia residents later filed a qui tam complaint under the FCA, alleging that Milliman and Optima had inflated those rates through purposefully misstated predictive...
Matt Arnold had done nothing wrong when a staff member approached him at the Sainsbury’s East Dulwich checkout. He had scanned his items, tapped his Nectar card, and was told he couldn’t be served...