Health insurance

Lexington judge finds health insurance company lied, delivers $ 4.7 million judgment [Lexington Herald-Leader]


November 30 – A so-called healthcare cost-sharing company that was once seen as “ruthless in denying coverage” by “Last Week Tonight’s” Jean Olivier, lost a $ 4.7 million trial in Lexington federal court.

The Aliera Companies, which created and marketed “fraudulent” health care coverage, lost a class action lawsuit, resulting in a $ 4.7 million judgement. A judge in a Lexington A federal court ruled against the company earlier this month after company officials repeatedly failed to appear in court, records show.

Senior District Judge, United States Joseph M. Hood stated that the company should have been subject to Kentucky the insurance laws because their claims of selling the Department’s healthcare sharing plans were inadequate. Members of health care sharing departments share medical expenses among themselves.

The ministry’s shared health care plans are not subject to the same regulations as insurance, but they must meet strict requirements. Aliera did not meet these requirements, Hood ruled.

“Aliera and her partners took advantage of hundreds of Kentuckians, many of whom trusted the company because it professed Christian beliefs,” Jay prather, one of the lawyers who continued the trial, said in a statement. “Aliara customers were looking for affordable health coverage to protect their families when needed.

“But when those tough times came, Aliera was more likely to shut the door on her own clients. Judge Hood is the first step in helping these families recover what they have lost. “

The class action lawsuit against Aliera, Trinity HealthShare and OneShare Health was prompted by Lexington residents Hanna albina and Austin Willard, according to court records. They alleged they fell victim to Aliara’s claims that she was offering health care sharing plans for the ministry.

Victims in the case have the right to terminate their contract with Aliera or reform their contract to bring it into line with applicable insurance law, Hood said. Some are entitled to reimbursement of their premiums or payment of unpaid claims.

How have KY clients been deceived or hurt?

Aliera has sold “inherently unfair and deceptive health care plans” to people, the lawyers wrote in the class action lawsuit. Aliera claimed health care plans were not insurance, which would avoid state oversight and patient protection and affordable care law mandates, according to the lawsuit.

Aliera claimed to have sold products from the “health care sharing ministry”, according to the lawsuit. Lawyers argued in the lawsuit that Aliara did not meet the requirements that shared healthcare companies must comply with.

Health care sharing ministries must be tax-exempt 501 (c) (3) organizations, their members must share a set of religious or ethical beliefs and the organization must have been in business for December 1999, according to the lawsuit.

“At no time has the for-profit association Aliera met the definition of an HCSM,” the lawyers wrote in the lawsuit.

Aliera created, marketed, sold and administered health care plans for Unity HealthShare and Trinity HealthShare, companies that were supposed to be health care sharing ministries, according to the lawsuit. Unity HealthShare then renamed itself OneShare Health, according to court records.

“Aliera has sold, like Unity and Trinity, illegal health insurance plans to hundreds, if not thousands of Kentucky residents. These plans did not meet the basic minimum requirements for health care plans authorized under federal law, ”the lawyers wrote in the class action lawsuit.

Judge Hood sided with victims who bought a plane while Aleria was in partnership with Trinity, Hood ruled. Assuming that each policyholder would choose to receive the higher payout of these two options, Hood came to an overall judgment of $ 4.7 million, according to court records.

Trinity has since filed for bankruptcy, court records show.

The trial is not yet over, as Hood’s judgment only resolved the “fictitious HCSM policies” that Aliera sold through Trinity, according to attorneys representing the victims.

“During the first phase of its fraud, Aliera sold fake HCSM policies through Unity / OneShare,” the attorneys said in a statement after the ruling. “The case before the Federal Court of Lexington will continue until all claims against Aliera, Trinity and Unity / OneShare are fully resolved. “

Aliera, in court records, denied ever claiming to be a shared health care ministry.

“It is a for-profit entity that contracted with Unity and then Trinity (through its subsidiaries) to market memberships to their sharing programs and to create processes to facilitate the sharing of medical expenses. member to member, “Aliara’s lawyers wrote in court records. .

“Aliera has created a system designed to provide members with the ability to consent to their contributions being shared in real time, on a case-by-case basis with other members based on their needs. But, as previously stated, all members are informed that their requests for payment sharing may not be met – there is no guarantee of payment or compensation. “

The allegedly illegal plans resulted in Kentucky residents denied coverage for medical care, which was to be provided by law, according to the lawsuit.

Meanwhile, Aliera and the so-called health-care sharing ministry companies “have made exorbitant profits,” according to the lawsuit. Lawyers believed Aliara kept 84 percent of all payments made by Kentucky residents who bought allegedly illegal plans from Aliera.

The federal government requires regular health insurance companies to use 80 percent of the money paid by plan members for “health care costs and quality improvement activities.” But health-care sharing departments are exempt from this rule, which means they aren’t prevented from spending more money on general, administrative, and marketing costs, as Aliera would have done.

Aliera and the other companies “have unjustly enriched themselves by collecting unreasonable fees and commissions, while arbitrarily and unreasonably refusing to pay the medical claims of class members,” the lawyers wrote in the lawsuit.

Aliera responded to the class action by asking the court to either dismiss the case or force those bringing the action to submit their claims to arbitration.

Lawyers for the company argued in court records that the people who filed the lawsuit “had failed to arbitrate their differences before initiating the lawsuit. However, the company failed to resolve any issues. made his case by going to court.After Aliara found himself in default, Hood ruled against them.

“Since we started working with the victims of this fraud two years ago, we have had two objectives: to put an end to the fraud and to obtain compensation for its victims”, Jay varellas, one of the lawyers working with the victims in the case, said in a statement.

“With the bankruptcy of Trinity, the fraud is now over and we will focus on recovering the funds to compensate those who have been victimized by Aliera, Trinity and OneShare Health. “

This story was originally published November 30, 2021 12:49.

___

(c) 2021 the Lexington Herald-Leader (Lexington, Ky.)

Visit the Lexington Herald-Leader (Lexington, Ky.) At www.kentucky.com

Distributed by Tribune Content Agency, LLC.