NORFOLK, Va. — The Department of Justice is looking into whether Sentara Health, and its subsidiary Optima Health, unfairly raised insurance premiums and earned more than $655 million in federal subsidies.
For several years starting in 2018, Sentara Health Plans ran the market in Hampton Roads. That's because at that time Anthem Blue Cross Blue Shield exited the market for the Affordable Care Act open enrollment period.
Court documents report in 2018 and 2019 Sentara premiums increased on average 81.8 percent, in some instances increased as high as 265 percent, and earned millions in federal subsidies.
Court documents also said Charlottesville customers saw premium increases at the top of the range.
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"For those Virginians, the rates were the highest in the country with the least expensive insurance option costing more than twice the national average," court documents filed by the government read.
Last month a judge ordered former Optima executives to provide additional testimony. The DOJ said Sentara hadn't complied with all its requests for documents and testimony.
Mike Kafka, Sentara Spokesperson, said Sentara's been working to comply with the investigation for the past three years. He sent this statement to News 3 on Tuesday:
“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.”
