Florida health system sues bill-sharing ministry for non-payment – Healthcare Dive


Healthcare sharing ministries are faith-based organizations that have gained popularity in recent years as a cheaper alternative to health insurance. Before the Affordable Care Act’s insurance mandate was repealed, HCSM members also were exempt from the tax penalty on people without coverage.
But the cost-sharing programs, which collect payments from members, are not subject to minimum standards of coverage and other requirements that apply to insurers under the ACA. HCSMs have attracted attention from state regulators who have expressed concerns that some organizations may mislead consumers into thinking that coverage is guaranteed for claims.
California Attorney General Rob Bonta in January sued one group, Atlanta-based Aliera Companies, accusing the business of scamming consumers by selling unauthorized health plans through Sharity Ministries and collecting hundreds of millions of dollars in monthly premiums while declining to pay members’ medical claims. Sharity Ministries filed for bankruptcy protection in 2021.
In its complaint against Liberty HealthShare, Orlando Health said it received a letter from Liberty in August 2021 stating the HCSM owed the hospital system about $1.1 million. But Liberty did not provide any patient names, procedures, services, dates, account numbers or other information to identify the claims, and it did not respond to a subsequent request from the hospital system for a list of accounts to verify the outstanding account balances.
Liberty stated that discrepancies with the claims involved the organization’s 90-day waiting period, “when Medicare is primary,” and that conditions associated with lifestyle and “other moral choices that are outside of our program’s values and beliefs,” according to the suit.
Orlando Health said it was unaware of any patients who were Liberty members or even that the HCSM owed it money when it received the August 2021 letter, but later learned that Liberty instructed patients to “intentionally conceal information” from the hospital operator. Orlando Health said it had no record of patients that identified Liberty as an outside source of funding for medical costs during the patient intake and registration process.
The hospital system asked the court for a full accounting of all medical services it provided to Liberty’s members and the discrepancies referenced in the organization’s letter, in addition to all amounts due for the care it provided to those patients.
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Topics covered: M&A, health IT, care delivery, healthcare policy & regulation, health insurance, operations and more.
In an interview, Kelly Bliss teased upcoming clients for a new virtual-first primary care product and parsed out Teladoc’s growth strategies for 2022 and beyond.
Advocate Aurora CEO Jim Skogsbergh said "partnering for health plan capability is going to be critical to our success, and we are taking steps to do that."
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