Common Ground Healthcare Cooperative v. United States
Common Ground Healthcare Cost-Sharing Reductions Class Action
Case No. 17-877 C

Frequently Asked Questions

 

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  • You were mailed a notice because government records show that you offered one or more Qualified Health Plans (“QHPs”) under the Patient Protection and Affordable Care Act (“Affordable Care Act”) in the 2017 and/or 2018 benefit years, and that you made cost-sharing reductions to eligible insureds for which you have not received reimbursement from the federal government.

    The purpose of this notice is to inform you of a class action lawsuit regarding unreimbursed cost-sharing reduction amounts for those two benefit years, to advise you of how your rights may be affected by this lawsuit, and to inform you how you can join or “opt in” to the lawsuit if you choose to do so. The class action lawsuit is called Common Ground Healthcare Cooperative v. United States, Case No. 17-877 C. This lawsuit is pending in the United States Court of Federal Claims.

  • Plaintiff Common Ground Healthcare Cooperative claims that Defendant United States has not made cost-sharing reduction reimbursements on a timely and periodic basis for the 2017 or 2018 benefit years to which it and other QHP issuers such as your organization are entitled under the Affordable Care Act. Section 1402 of the Affordable Care Act established a cost-sharing reduction program that applied to insurers who offered QHPs on the Affordable Care Act’s insurance exchanges. The cost-sharing reduction program provides that QHP issuers must pay a portion of eligible insureds’ out-of-pocket costs, such as deductibles, co-pays, and similar expenses, thereby reducing the amount eligible insureds must pay. Section 1402 further states that the Secretaries of the Department of Health and Human Services (“HHS”) and the Treasury “shall make periodic and timely payments to the [QHP] issuer equal to the value of the reductions.” Beginning in 2014, the United States began making these cost-sharing reduction reimbursements, but then ceased paying them in 2017 and continues to not pay them.

    In November 2017, Plaintiff Common Ground Healthcare Cooperative amended a previously filed class action lawsuit in the United States Court of Federal Claims to add a claim alleging that the Government violated Section 1402 of the Affordable Care Act and its implementing regulations by failing to make “periodic and timely” cost-sharing reduction reimbursements. Plaintiff claims that the Class is entitled to relief under the Tucker Act, a federal statute that provides the United States Court of Federal Claims with jurisdiction to award money judgments against the federal government where a statute is money-mandating and requires payment. The case was assigned to Judge Margaret M. Sweeney. On April 17, 2018, the Court entered an order granting class certification and appointing Quinn Emanuel Urquhart & Sullivan, LLP as lead counsel for the Class. 

     More detailed information about this lawsuit is contained in the Class Action Complaint filed in this lawsuit. The Class Action Complaint is available on the Important Documents page.

  • Common Ground Healthcare Cooperative, the Plaintiff that filed this class action, seeks the following on behalf of itself and the Class:

    • Payment from the United States of the full amount of unreimbursed cost-sharing reduction payments for the 2017 and 2018 plan years pursuant to section 1402 of the Affordable Care Act and its implementing regulations;

    • Payment to the lawyers who represent Common Ground Healthcare Cooperative who filed this lawsuit, as well as their expenses and fees associated with bringing and prosecuting this lawsuit—such payment would be drawn from any judgment, settlement, or other recovery obtained by Common Ground Healthcare Cooperative and the Class; and

    • The award of any other relief that the Court deems just and proper.

  • In a class action lawsuit, one or more people or entities called “Class Representatives” (in this case Common Ground Healthcare Cooperative) sue on behalf of other people or entities who have similar claims. These people or entities together are a “Class” or “Class members.” The people or entities who sued—and all the Class Members who join the lawsuit—are called “Plaintiffs.” The party or entity against whom the lawsuit is brought is called a “Defendant.” Here, the United States is the Defendant, because it is the party ultimately responsible for paying cost-sharing reduction amounts owed under the Affordable Care Act. The Court of Federal Claims will resolve all legal and factual issues for every eligible Class Member who timely submits a Class Action Opt-In Notice Form. Those individuals who do not timely submit a Class Action Opt-In Notice Form will be excluded from the Class in this case.

    More information about why the Court has allowed this lawsuit to be a class action is located in the Court’s Order Certifying the Class, available on the Important Documents page.

  • You will need to decide whether you wish to join this lawsuit as a Class Member. You are not part of the Class unless and until you filled out and submitted the Class Action Opt-In Notice Form you received in the mail. Rule 23 of the Rules of the United States Court of Federal Claims requires that Class Members wishing to participate in this class action must join or “opt in” to this class action lawsuit. 

    Please Note: This “opt in” procedure is different than many other class action lawsuits in the United States because, if do you do nothing, you will not be able to participate in the lawsuit as a Class Member.

  • Under the Rules of the United States Court of Federal Claims, the Court has allowed the lawsuit to be a class action on behalf of the following:

    All persons or entities offering Qualified Health Plans under the Patient Protection and Affordable Care Act in the 2017 or 2018 benefit year, and who made cost-sharing reductions for eligible insureds pursuant to Section 1402 of the Patient Protection and Affordable Care Act, but did not receive a “timely and periodic” payment from the Government of an amount “equal to the value of the reductions” provided to its insureds. Excluded from the Class are the Defendant and its members, agencies, divisions, departments, and employees.

  • The deadline to participate in this lawsuit was August 13, 2018.

  • If you are eligible to be a Class Member and choose to join the Class, you will receive any monetary or other benefits obtained from the lawsuit. A judgment in this case will be binding on you, meaning you could not pursue your own separate lawsuit using your own attorney. Similarly, you may be bound by, and can share in, any settlement reached on behalf of the Class. In the event Class Counsel and the United States reach a settlement, you will receive notice of the settlement and you may object to the settlement and be heard by the Court on your objection. In the case of any settlement reached before entry of judgment, Class Counsel may seek to decertify the litigation class and recertify a settlement class, which would allow any Class Members that previously opted in to decide whether to join the settlement class at that time.

    Any person or entity who submits a Class Action Opt-In Notice Form to join the Class need not appear in Court in order to participate. If you become a Class Member, your interests will be represented by the Class Representative and Class Counsel. Ultimately, the Court will rule on whether you are entitled to compensation and, if so, the amount of compensation owed to you.

    In order to join the Class, you must have submitted a Class Action Opt-In Notice Form by Monday, August 13, 2018. This means your Class Action Opt-In Notice Form must have been submitted electronically on the Electronic Opt-In Submission page, received by facsimile, postmarked, or hand-delivered by Monday, August 13, 2018.

  • You will not have to pay any money out-of-pocket to participate in the Class Action. If the Class is successful in this litigation, however, Class Counsel will ask the Court’s permission to be compensated for litigating this case and representing the successful Class. Any sums received by Class Counsel in compensation will be deducted from any recovery, which will proportionately reduce the amount of any award each Class Member receives. If the case is unsuccessful, you will have no obligation for attorneys’ fees or costs.

    Class Counsel represents that it will request no more than 5% of any judgment or settlement obtained for the Class. The fee may be substantially less than 5% depending upon the level of class participation represented by the final membership of the Class. In any event, the exact percentage of Class Counsel’s fees will be determined by the Court subject to, among other things, the amount at issue in the case and what is called a “lodestar cross-check” (i.e. a limitation on class counsel fees based on the number of hours actually worked on the case). See, e.g., Geneva Rock Products, Inc. v. United States, 119 Fed. Cl. 581, 595-96 (2015); Loving v. Sec’y of Health and Human Servs., 2016 WL 4098722, at *4 (Fed. Cl. Spec. Mstr. July 7, 2016).

  • If you did not submit a Class Action Opt-In Notice Form electronically, postmarked, faxed, or hand-delivered on or before Monday, August 13, 2018 you cannot participate as a Class Member in this case. As a result, you will not receive any money or benefits from the Court for this lawsuit. However, you keep the right to hire your own lawyer to sue the United States separately about the same legal claims in this lawsuit and you will not be legally bound by any decision of the Court in this class action.

  • The Court has decided that attorneys at the law firm of Quinn Emanuel Urquhart & Sullivan, LLP, led by partners Stephen Swedlow, J.D. Horton, and Adam Wolfson, are qualified to represent you and all Class Members. Quinn Emanuel Urquhart & Sullivan, LLP is called “Class Counsel.” Class Counsel has experience handling this type of lawsuit. More information about Class Counsel is available at www.quinnemanuel.com.

  • You do not need to hire your own lawyer because Class Counsel will work on your behalf and represent your interests if you join the Class. You have the right to have your own lawyer. Your own lawyer can appear in court for you if you want someone other than Class Counsel to speak on your behalf. If you choose to hire your own lawyer, you will have to pay that lawyer.

  • If the case is not resolved by a settlement, summary judgment, or otherwise, Class Counsel will have to prove the claims of Plaintiff and the Class at trial. The parties are currently in the pleadings phase. At this juncture, Plaintiff has filed a complaint detailing their claims and the Government will be given an opportunity to either respond or move to dismiss those claims. At a trial, the judge would hear all of the evidence to reach a decision about whether Plaintiff or Defendant is right about the claims in this case.

  • You do not need to attend the trial. Class Counsel will present the case on behalf of all Class members. You and/or your own lawyer are welcome, and entitled, to attend the trial at your own expense.

  • If the Class is successful and obtains money as a result of the trial or a settlement, you will be notified about how to participate and receive your share. The parties at this time do not know how long this will take.

  • If you have additional questions about this Notice, you may review the case documents on the Important Documents page, or contact Class Counsel directly:

    Stephen A. Swedlow, Esq.
    Quinn Emanuel Urquhart & Sullivan, LLP
    191 N. Wacker Drive, Suite 2700
    Chicago, IL 60606
    (312) 705-7400
    stephenswedlow@quinnemanuel.com


    Please do not contact the United States Court of Federal Claims with questions or requests for information.

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Mail

CSR Class Action
c/o JND Class Action Administration
PO Box 91349
Seattle, WA 98111