Sentara under US DOJ investigation for premium hikes

Sentara Healthcare and its subsidiaries are currently under investigation for potentially misleading regulators in Virginia to increase their plans to higher prices during 2018-2019. The key point of the investigation is Sentara Health Plans, which was known at the time as Optima Health. Sentara Healthcare faces an accusation by the Department of Justice that they falsely made claims for premium tax credits to the U.S. while raising premiums for customers, violating the False Claims Act.

The alleged behavior occurred during a time in which Sentara Healthcare did not have much competition in the market and had the ability to control pricing by raising their premiums, since customers may not have had many other options. 

The changes in pricing were not minor; individual plans were raised by an average of 81.8% in 2018 compared to 2017. Depending on where citizens lived, some increases were as high as 265.5%, according to WAVY, a local news source.

The Virginian-Pilot reported on Ian Dixon’s case as an example of these spiked premiums. His family’s premium went from $988 a month to $3,158 a month.

The increase in these premium prices can be difficult to monitor, especially for younger people getting their feet wet in becoming more responsible with healthcare and other issues.

Sentara said that “policymakers in Washington destabilized health insurance markets,” and the raised prices were a result of that. 

“After hearing about Sentara spiking their prices, I went back to check my statements to make sure that I was not overcharged for any of my copays,” senior Biochemistry major Sandra Abdellah said.

The investigation itself does not involve copays, but Abdellah is suspicious of what other prices Sentara and other hospitals raise. The case has created some controversy as to whether these hospitals are meant to make money first or help patients first.

“Raising insurance policies leaves people with no choice but to pay up,” Abdellah said. 

According to WAVY, Sentara earned more than $535 million in federal subsidies the same year. Sentara has continued to deny these claims of overcharging clients and said that they plan to continue working with investigators to make things right.

The Atlanta Journal-Constitution reported that a fifth of U.S. hospitals have been warned about secretly increasing pricing.

Abdellah will continue to personally monitor the situation, especially after reading what Sentara Spokesperson Mike Kafka said to the public.

“I read the statement, and it appeared to me like a lot of excuses and not much explanation. I will definitely be double-checking the charges before I swipe my card for a doctor’s appointment,” Abdellah said.

The Daily Progress reported that Kafka said their rates were approved by the Virginia Bureau of Insurance and the Centers for Medicaid and Medicare Services. In his statement to the public, Kafka said, “These rates were verified by a leading independent actuarial firm and approved twice by Virginia regulators.”

Sentara, in an official statement, said, “As it has for nearly three years, Sentara will continue to operate in good faith and looks forward to a resolution of this matter.” Sentara denied all accusations. 

By Coy Camiscioli