Where relators grounded their False Claims Act claims on the allegation that health care insurers grossly inflated insurance premiums in violation of the Affordable Care Act, but resolving that claim would require the court to second-guess the rates approved by Virginia regulators, the suit was dismissed as barred by the filed-rate doctrine.
Background
Relators brought this qui tam action against defendants Sentara and Milliman, Inc. Pending before the court are motions to dismiss that were filed by Sentara and Milliman, arguing the claims in the first amended complaint, or FAC, are barred by the filed-rate doctrine.
Filed-rate doctrine
The federal filed-rate doctrine is a judicially created doctrine that initially arose in the context of carrier rates. Many courts have subsequently applied the doctrine—or a state counterpart—in the field of insurance. In general terms, the doctrine precludes attacks through judicial cases on regulator-approved rates—or, in some circuits, rates filed with regulators and not disapproved—and essentially prevents a court from determining whether a filed rate is reasonable.
A threshold question exists here about whether the court should apply the federal filed-rate doctrine or a state counterpart, if one exists. In this case, the state regulatory agency was acting pursuant to a federal law (the Affordable Care Act, or ACA), and relators’ claims are all asserted under federal law (the False Claims Act, or FCA). And the parties’ briefing...
Where relators grounded their False Claims Act claims on the allegation that health care insurers grossly inflated insurance premiums in violation of the Affordable Care Act, but resolving that cl...