A whistleblower lawsuit accusing Norfolk-based Sentara Health of exploiting its monopoly to saddle Charlottesville with the nation’s highest Affordable Care Act premiums was dismissed at the end of July as a federal judge ruled that courts cannot second-guess insurance rates approved by state regulators.
“The federal filed-rate doctrine bars the claims here, which directly challenge rates approved by the Virginia Bureau of Insurance,” Chief U.S. District Judge Elizabeth Dillon wrote in her 32-page opinion.
The three Charlottesville whistleblowers — Ian Dixon, Karl Quist and Sara Stovall — say they will appeal. “Of course,” Stovall texted The Daily Progress shortly after the ruling was issued July 31.
The lawsuit traces back to 2017, when Anthem and Aetna abandoned Virginia’s Affordable Care Act marketplace, leaving a large swath of Central Virginia with just a single option: a Sentara subsidiary called Optima Health.
The whistleblowers alleged that Sentara, aided by actuarial consulting firm Milliman Inc., used that monopoly power to dramatically inflate premiums while absorbing federal premium tax credits to cushion consumers from some of the increase.
Still, according to the complaint, Charlottesville’s rates became the highest in the nation.
The suit offered an example: A family of four paying $940 a month for Anthem’s least expensive plan in 2017 attempting to get insurance the following year would have faced a $2,920 monthly premium for Optima’s cheapest plan — along...
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