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Blue Cross insurer sues Feds over risk corridor payments; wants $130 million

Blue Cross Blue Shield of North Carolina is second insurer to bring lawsuit against federal government over back payment.

Susan Morse, Senior Editor

BCBSNC filed suit in the US Court of Federal Claims. Photo by <a href="https://upload.wikimedia.org/wikipedia/commons/7/7c/United_States_Court_of_Federal_Claims.JPG"> Wikipedia </a>BCBSNC filed suit in the US Court of Federal Claims. Photo by Wikipedia

Another insurer is suing the federal government to recover risk corridor payments it says it is owed under the Affordable Care Act.

Blue Cross Blue Shield of North Carolina is seeking $130 million from the government for payments owed for 2014, the insurer said.

BCBS of North Carolina also wants assurances that full risk corridor payments for 2015 and 2016 will be made. The insurer estimates the government will owe it more than $175 million for 2015.

In May, Highmark brought a similar lawsuit, claiming it was owed $223 million for 2104 payments.

BCBS of North Carolina says it is owed the payments by law for offering a health plan on the exchanges in North Carolina.

[Also: Highmark sues federal government to recover $223 million it claims it is owed in ACA payments for 2014]

The government has acknowledged it is obligated to pay the insurer  approximately $147 million in risk corridor payments for 2014, but has only paid BCBSNC approximately $18 million of that amount, a shortfall of nearly 90 percent, the insurer said in a statement.

They filed the suit in the United States Court of Federal Claims in Washington, DC.

The federal government's failure to make full payment has exacerbated BCBSNC's losses in the exchange market in 2014 and 2015, the insurer said, adding it has made it significantly more challenging to continue selling ACA products.

BCBSNC lost more than $400 million on its ACA products in 2014 and 2015, the insurer said.

[Also: Anthem Blue Cross Blue Shield, Aurora Health Care form joint health insurance company to offer network plan]

Congress designed the temporary risk corridor program to provide financial stability for insurers and consumers during the first few years of the ACA and to encourage more insurers to participate.

"BCBSNC's decision to participate in this new, volatile ACA marketplace was impacted by our reliance on the government's assurances that the risk corridor program was in place to provide some protection against the significant losses we have suffered," said BCBSNC General Counsel King Prather. 

BCBSNC serves close to 4 million members, including approximately 1 million served on behalf of other Blue Plans. 

Twitter: @SusanJMorse