February 2019

Insurer Wins Landmark Ruling in ACA Cost-Sharing Reduction (CSR) Payments Litigation

North America - United States | North America

Community Health Choice prevailed in a lawsuit alleging the federal government owed them for unpaid cost-sharing reduction (CSR) payments. Faegre Baker Daniels represented the health insurer, arguing that the federal government violated 42 U.S. Code § 18071, an Affordable Care Act (ACA) provision designed to compensate insurers for the cost of reducing the deductibles and co-pays of policyholders whose household income was below 250% of the poverty line.

The U.S. Federal Court of Claims determined that the federal government violated a money-mandating statute and breached an implied-in-fact contract and that Community Health Choice was entitled to $71.5 million in back payments.

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