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Court of Federal Claims Grants Summary Judgment on $214 Million ACA "Risk Corridors" Claim

February 10, 2017

In Moda Health Plan, Inc. v. U.S. (Feb. 9, 2017), the Court of Federal Claims granted summary judgment in favor of a health insurer in a lawsuit seeking to recover "risk corridors" payments pursuant to §1342 of the Affordable Care Act, deciding on the merits that (i) the plaintiff was entitled to full payments owed to it under the statutory formula set forth in the ACA, (ii) Congress did not intend the risk corridors program to be budget-neutral, and (iii) later appropriations bills restricting HHS' access to the CMS Program Management Account for risk corridors payments did not repeal or amend this obligation to make full annual payments. In an important decision likely to reverberate throughout the individual insurance market, the Court stated that "the Government made a promise in the risk corridors program that it has yet to fill … [and] the Court directs the Government to fulfill that promise."

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