Federal investigators say Norfolk-based Sentara Health’s insurance subsidiary misled regulators in 2018 and 2019 when it significantly increased premiums in Hampton Roads and areas across the state. We are investigating whether this is the case.
Sentara Health Plans, then known as Optima Health, announced in 2017 that it would raise 2018 premiums in Hampton Roads by an average of 81% for individual plans, The Virginian-Pilot reported. Anthem Blue Cross Blue Shield was taken off the market during Hampton Roads’ 2018 Affordable Care Act open enrollment period, leaving Sentara the only game in town.
The U.S. government is currently investigating whether Sentara unfairly increased premiums for those policies because it earned more than $655 million in federal subsidies, according to documents filed in federal court. This was reported by the Charlottesville Daily Progress newspaper. Department of Justice investigation in January. Sentara denies his claims of overcharging customers and misleading regulators and said it is cooperating with the investigation.
On March 8, Judge Elizabeth K. Dillon of the U.S. District Court in Roanoke ordered Michael Dudley, Optima’s former president and CEO, and Optima’s chief accountant, according to recently released court records. He ordered James Juillat to submit additional sworn testimony within 60 days. Justice Department lawyers said Sentara complied with some requests for documents and testimony, but he did not comply with others. The ruling requires nonprofit medical organizations to provide these documents and testimony.
Charlottesville garnered national media attention; Including one from the New York Times, customers learned that their monthly premiums would increase dramatically in 2018. In some cases, he would pay two or three times what he was previously paying.
Ian Dixon, a software developer in Charlottesville, learned his insurance premiums for his family of four would go from $988 a month to $3,158 a month. To avoid these fees, Dixon hired another employee at his company, lowering his monthly costs to about $1,500. Paying that salary was cheaper than paying insurance premiums, he said.
Since then, Dixon said he has spent many hours researching why interest rates have risen so much. He said he wants accountability from Sentara.
“This changed people’s lives forever,” Dixon said. “It was very disruptive. It was very harmful.”
Sentara spokesman Mike Kafka said in an email that the company has worked diligently with federal investigators, providing more than 27,000 documents and approximately 70 hours of interviews with current and former employees. Ta.
Kafka defended Sentara’s decision to enter after Anthem left the market in 2017, saying the company had just 26 days to develop an insurance plan. He said if Sentara had not taken action, more than 350,000 people could have been uninsured on the exchange.
“These rates have been verified by a large independent actuarial firm and twice approved by Virginia regulators,” he said.
Sentara also agreed to allow former CEO Howard Kahn to testify regarding his role in the process, according to court documents. Reached by phone, Khan declined to comment on the investigation.
The government has been investigating Sentara since 2021, according to the documents. Lawyers for Sentara have fought to have the court records sealed, arguing that unsealing them would damage the reputation of the health care system and other parties. However, Mr. Dillon ruled that the nonprofit system did not provide any countervailing benefits that outweighed the public’s right to access.
Trevor Metcalfe, 757-222-5345, [email protected]
