The suit alleges that Aliera falsely represented Sharity/Trinity as a legitimate HCSM that satisfied the ACA's standards for exemption.
California Attorney General Rob Bonta has filed a lawsuit against The Aliera Companies and the Moses family, founders of Sharity Ministries, Inc., alleging that the payer bilked consumers out of premiums.
According to the suit, Atlanta-based Aliera, a for-profit company, created and ran Sharity (formerly called Trinity Healthshare, Inc.), as a nonprofit corporation that purported to be a healthcare sharing ministry.
However, the suite notes that Aliera has never fit the legal definition of an HCSM, which requires that they be an IRS 501(c)(3) nonprofit in existence since December 31, 1999.
The suit alleges that Aliera falsely represented Sharity/Trinity as a legitimate HCSM that satisfied the ACA's standards for exemption.
The nonprofit payer allegedly collected hundreds of millions of dollars from beneficiaries across the nation, but declined claims and kept nearly 84% of premiums, enriching the owners but leaving many beneficiaries with crushing medical debts, the AG said.
"Aliera preyed on consumers who, in many cases, thought their monthly payments were being used to help others who shared their faith and religious beliefs," Bonta said in a media release. "Instead, Aliera and the Moses family funneled its members’ payments into their own pockets.”
"When members suffered medical emergencies, their problems were compounded by Aliera claiming it had no obligation to pay medical costs, he said. "Aliera's sham business is unlawful and our lawsuit seeks to ensure they are held to account to pay the price for the Californians they lured in and cheated."
Aliera did not repsond to HealthLeaders' request for comment.
Before the Affordable Care Act, HCSMs allowed people to pool their money with others who shared their religious beliefs to assist one another during times of medical crisis.
Some companies also began to capitalize on the exemption of HCSMs from many of the coverage mandates in the ACA by marketing their plans as a less-expensive alternative to ACA-compliant health insurance.
However, HCSMs do not guarantee payment for covered services or coverage for essential health benefits, like birth control, prescriptions, preexisting conditions, and mental health care.
Peter V. Lee, executive director of Covered California, said the allegations "provide a chilling reminder of the dark days of health insurance, when some companies took advantage of people by offering Swiss-cheese coverage that was full of holes, when benefits were routinely rejected and people were left with enormous medical bills."
In April 2021 Bonta's office issued a consumer alert after fielding consumer complaints alleging that their HCSM plans refused to cover treatments and pay their medical bills.
“Aliera preyed on consumers who, in many cases, thought their monthly payments were being used to help others who shared their faith and religious beliefs.”
California Attorney General Rob Bonta
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
KEY TAKEAWAYS
The suite notes that Aliera has never fit the legal definition of an HCSM, which requires that they be an IRS 501(c)(3) nonprofit in existence since December 31, 1999.
The suit claims the nonprofit payer allegedly collected hundreds of millions of dollars from beneficiaries across the nation, but declined claims and kept nearly 84% of premiums, enriching the owners but leaving many beneficiaries with crushing medical debts.