NORFOLK, Va. (WAVY) — Federal investigators are conducting an investigation into whether Sentara Healthcare or any of their subsidiaries intentionally misled regulators in Hampton Roads and around the state, in 2018 and 2019.
10 On Your Side reviewed the 33-page court document filed in U.S. District Court Western District of Virginia.
It states, in 2018, Sentara Health Plans, known at the time as Optima Health, rose insurance premiums for individual plans by an average of 81.8% compared to 2017. This was at the same time they were receiving more that $535 million in federal subsidies, according to court documents.
The increase was actually as high as 265.5% depending on where the individual lived, among other factors.
Sentara gave the following statement in response to the investigation:
Sentara has provided more than 27,000 documents and approximately 70 hours of interviews from seven former and current employees to date in response to the DOJ’s inquiry. This recent ruling on procedural matters will help clarify the process moving forward. As it has for nearly three years, Sentara will continue to operate in good faith and looks forward to a resolution of this matter.
In 2017, when policymakers in Washington destabilized health insurance markets, more than 350,000 Virginians were at risk of not having access to any insurance on the exchanges. Sentara had a choice: follow the same path as some of the biggest insurers and exit, or work with state and federal officials to ensure residents of Charlottesville and other regions still had access to an ACA-eligible plan. At the urging of state and federal officials, Sentara formulated rates in just 26 days that normally take six months or more to develop. These rates were verified by a leading independent actuarial firm and approved twice by Virginia regulators.
Sentara stood with Virginians then and remains steadfast now in our commitment to providing comprehensive, high-quality care for Virginia communities.” – Mike Kafka, Sentara Spokesperson
The document claims if Optima charged inflated rates, this would increase the total amount of subsidies given by the government, which in turn could mean more people may have qualified for subsidies.
In 2021, the United States served Sentara via certified mail at their Norfolk headquarters, where they were notified that the “False Claims Act investigation concerns allegations that Sentara Healthcare and/or its subsidiaries knowingly filed false health insurance rate filings in 2018 and 2019 for the Affordable Care Act insurance marketplace in Virginia, thereby causing the submission of false claims for premium tax credits to the United States, in violation of the False Claims Act.”
Sentara has denied claims of overcharging and misleading regulators, saying they are cooperating with the investigators.
Continue to check WAVY.com for updates.