In a recent development, a federal judge has ordered further testimony from Sentara executives amidst a Department of Justice probe into allegations of inflated premiums and $665 million in undue profits. This order comes as the company bids for a Florida Medicaid contract, adding more complexity to the ongoing investigation.
The case revolves around claims that Sentara, formerly known as Optima Health, unfairly raised insurance premiums in 2018 and 2019, resulting in an excess profit of $665 million. The focus of the investigation is primarily on whether the company misled federal regulators about insurance rates after becoming a primary insurer in Virginia’s Affordable Care Act marketplace.
Sentara is accused of withholding 8,000 pages of relevant information until after key testimonies were given, raising suspicions. Despite the company’s claims that the documents did not contain new information, federal attorneys argue that they were crucial to the case deliberations and should have been shared earlier.
The investigation led Judge Elizabeth K. Dillon in Roanoke, Virginia to order former Optima CEO Michael Dudley and Optima chief actuary James Juillerat to provide sworn testimony within 60 days of the ruling. This move signifies a critical step in unraveling the complexities of the case.
As the legal battle unfolds, the spotlight remains on the alleged misrepresentations made by Sentara in their rate filings for ACA plans in Virginia. The case, intertwined with an ongoing federal investigation, seeks to determine the legitimacy of the rate filings under the regulations of the False Claims Act.
With Florida’s Agency for Health Care Administration currently engaged in the re-procurement of Medicaid managed care contracts, the final decision on the recipients of the lucrative contracts is eagerly anticipated. This routine but essential procedure will determine which healthcare providers will manage Medicaid services in the state, impacting millions of residents.
Stay tuned for further updates as the legal saga surrounding Sentara continues to unfold, casting a shadow over the healthcare landscape in Virginia and beyond.
