The chief executive of UnitedHealth Group is out.

Anthem said in a statement on Monday that CEO Mark Bertolini has been fired effective immediately.

Bertolini was CEO of the troubled health insurer in 2010.

Anthem, which was founded by Bertolini and his brother Mark, was sold in 2012 to Humana.

Anthem had about 15 million people enrolled in its Obamacare plans.

The company had $20 billion in losses in 2016.

Bertoli is the fourth CEO to leave the company in less than a year.

The other three have been ousted by their companies’ board.

Bertetti, who led the company through a period of financial crisis in the mid-2000s, was a vocal critic of the healthcare law and criticized its cost-sharing subsidies.

Anthem was one of several health insurers that was left out of the federal government’s cost-shifting rules.

The president has said he wants to make sure all health insurers are on the same footing, and Bertolini, who has been outspoken about the law, has said it was a mistake to not include them.

Anthem’s announcement came a day after Humana announced it would lay off more than 400 employees and close a second headquarters in Cincinnati.

Anthem has said that while it plans to bring back some employees, the company won’t open new locations in Ohio.