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Highmark sues feds over ACA payments
Modern Healthcare

Health insurer Highmark is suing the federal government to recover money owed under the risk-corridor program for plans sold on the Affordable Care Act’s insurance exchanges.

The lawsuit, filed in the U.S. Court of Federal Claims, argues Highmark is owed at least $223 million in risk-corridor payments. The ACA established risk corridors and two other risk-mitigation programs to help insurers weather the uncertain environment in the first few years of expanded health coverage.

However, Republicans in Congress stymied the risk-corridors program, calling it an insurance industry bailout, thereby allowing HHS to pay only 12.6% of risk-corridor payment requests for 2014. The same will hold true for 2015 risk-corridor payments. Medicare Part D has its own version of risk corridors.