Gerhart v. United States Department of Health & Human Services

242 F. Supp. 3d 806, 2017 U.S. Dist. LEXIS 37620, 2017 WL 1019816
CourtDistrict Court, S.D. Iowa
DecidedMarch 16, 2017
DocketNo. 4:16-cv-00151-RGE-CFB
StatusPublished
Cited by3 cases

This text of 242 F. Supp. 3d 806 (Gerhart v. United States Department of Health & Human Services) is published on Counsel Stack Legal Research, covering District Court, S.D. Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gerhart v. United States Department of Health & Human Services, 242 F. Supp. 3d 806, 2017 U.S. Dist. LEXIS 37620, 2017 WL 1019816 (S.D. Iowa 2017).

Opinion

ORDER RE: DEFENDANTS’ MOTION TO DISMISS

Rebecca Goodgame Ebinger, United States District Judge

I. INTRODUCTION

The Department of Health and Human Services seeks dismissal of the present suit. The Department asserts this Court does not have jurisdiction because the requested damages are purely monetary in nature and could be adequately addressed in the Court of Federal Claims. Defs.’ Mot. Dismiss, ECF No. 61. The co-operative liquidators resist this motion, asserting this Court has jurisdiction because money damages are insufficient to address their claims. Pis.’ Resist. Defs.’ Mot. Dismiss, ECF No. 69.

The matter came before the Court for hearing on December 15, 2016. Hr’g Defs.’ Mot. Dismiss Mins., ECF No. 78. Attorneys Charles Canter and Serena Orloff appeared on behalf of Defendants United States Department of Health and Human Services; Centers for Medicare and Medicaid Services; Thomas E. Price, in his capacity as Secretary of the United States Department of Health and Human Services; 1 and the United States.2 Id. Attorneys Mark Hill, Douglas Schmidt, and Derek Teeter appeared on behalf of Plaintiff Nick Gerhart, in his capacity as Liquidator of CoOportunity Health, Inc.,3 and Dan Watkins, in his capacity as Special Deputy Liquidator of CoOportunity Health, Inc.4 Id.

For the reasons stated below, the Court grants HHS’ Motion to Dismiss because the Court lacks jurisdiction over the Liquidators’ claims.

II. SUMMARY OF RELEVANT FACTS

The Court set forth an overview of the relevant facts in its August 12, 2016 order denying the Liquidators’ motion for a preliminary injunction. ECF No. 55 at 2-8. [809]*809Since then, the parties provided additional briefing regarding the federal programs at issue and supplemented the record as to the present relationship between HHS and the Liquidators. The Court provides a focused recitation of the programs and facts at issue.

In part, the Liquidators take issue with HHS’ treatment of the startup and solvency loans CoOportunity received and the Patient Protection and Affordable Care Act’s (ACA) “3Rs” program payments. The 3Rs program consists of three programs: reinsurance, risk adjustment, and risk corridors. See generally 42 U.S.C. §§ 18061-63. Issuers organized under the Consumer Operated and Orientation Plan (CO-OP) program — such as CoOportunity — are eligible to participate in all three programs. Establishment of Consumer Operated and Oriented Plan (CO-OP) Program, 76 Fed. Reg. 77,392-01, 77,406 (Dec. 13, 2011). The 3Rs program was enacted to stabilize the market while issuers adjusted their actuarial estimates and to encourage participation in the nascent insurance marketplace. The ACA’s 3Rs program is similar to the three mitigation programs enacted when Medicare Part D launched. See 42 U.S.C. § 1395w-115 (describing a permanent risk corridors program, a temporary risk adjustment program, and a permanent reinsurance program); 42 C.F.R. § 423.336 (same).

The reinsurance and risk corridors programs are temporary (transitional) programs for the 2014, 2016, and 2016 benefit years. See 42 U.S.C. §§ 18061(b)(1), 18062. The reinsurance program uses mandatory annual contributions to pay qualified issuers for a percentage of their high-risk (catastrophic) claims costs for individual enrollees. 45 C.F.R. §§ 153.220, 153.230, 153.235. The risk corridors program is “based on the ratio of the allowable costs of the plan to the plan’s aggregate premiums.” 42 U.S.C. § 18062(a). Under the risk corridors program, issuers pay HHS a penalty if their claims costs are less than their premiums (minus administrative costs) by a given percentage. Id. § 18062(b)(2). Conversely, HHS makes payments to issuers having greater claims costs than premiums (minus administrative costs) over a given percentage. Id. § 18062(b)(1). The third program, the risk adjustment program, is permanent. See id. § 18063. The risk adjustment program mandates payments from insurance pools with lower-than-average actuarial risk to insurance pools with higher-than-average actuarial risk. Prior to the end of the 2014 benefit year, HHS announced it would operate the 3Rs program as budget neutral. See 45 C.F.R. § 153.230(d) (“If HHS determines that all reinsurance payments requested ... for a benefit year will not be equal to the amount of all reinsurance contributions collected, ... HHS will determine a uniform pro rata adjustment.”); 160 Cong. Rec. H9838 (daily ed. Dec. 11, 2014) (noting that budget neutral means “the federal government will never pay out more than it collects from issuers over the three year period risk corridors are in effect”); HHS Notice of Benefit and Payment Parameters for 2014, 78 Fed. Reg. 15,410-01, 15,441 (Mar. 11, 2013) (“The Affordable Care Act risk adjustment program is designed to be a budget-neutral revenue redistribution among issuers.”). But see, e.g., 42 U.S.C. § 18062(b)(1) (providing HHS “shall pay” specified amounts to eligible issuers of qualified health plans); 45 C.F.R. § 153.510(b) (providing HHS “will pay” specified amounts to eligible issuers of qualified health plans).

Central to this suit is HHS’ calculation of the risk corridors payments. For the 2014 benefit year, issuers received a prorated rate (12.6%) for their risk corridors payments. Dep’t of Health & Human Servs., Ctrs. for Medicare & Medicaid Servs., Risk Corridors Payment and [810]*810Charge Amounts for Benefit Year 2014 (Nov. 19, 2015), https://www.ems.gov/ CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/Downloads/RC-Issuer-level-Report.pdf [hereinafter 2014 Risk Corridors ■ Calculation]. Monies collected for the 2015 benefit year have been and will be used to pay the shortfalls from the 2014 benefit year. Defs.’ Ex. 2, Reply Supp. Defs.’ Mot. Dismiss 1-2, ECF No. 72-3 (letter dated September 9, 2016, estimating no funds will be available for 2015 benefit year risk corridors payments and stating funds collected will be used for 2014 benefit year risk corridors payments)-; see also Dep’t of Health & Human Servs., Ctrs. for, Medicare & Medicaid Servs., Risk Corridors Payment and Charge Amounts for the 2015 Benefit Year (Nov. 18, 2016), https://www.cms.gov/CCIIO/ Resources/Regulations-and-Guidance/ Downloads/2015-RC-Issuer-level-Report-ll-18-16-FINAL-v2.pdf [hereinafter 2015 Risk Corridors Calculation]. The final risk corridors calculation will be based on the 2016 benefit year. The risk corridors payments for the 2016 benefit year are expected to be remitted starting in August 2017.

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242 F. Supp. 3d 806, 2017 U.S. Dist. LEXIS 37620, 2017 WL 1019816, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gerhart-v-united-states-department-of-health-human-services-iasd-2017.