Minnesota attorney general asks U.S. to investigate Humana

Karen MerrickMinnesota Attorney General Lori Swanson said patients and doctors are having “significant problems” with Humana.

Minnesota Attorney General Lori Swanson is asking the federal government to investigate Humana’s Medicare Advantage policies after uncovering what she said were “significant problems” reported by Minnesota patients and medical providers.

Affidavits gathered from 25 Minnesotans showed a pattern where Humana denied claims for medical services required by law, overcharged for co-payments and coinsurance, and failed to disclose the providers that are in the network, she said. Swanson’s office also found that Humana didn’t follow procedures laid out by federal regulations for patients to appeal their cases.

“They were stringing people along, taking months to get back to people,” she said. “Oftentimes, it took the intervention of our office — and oftentimes we had to write multiple times.”

Humana, based in Louisville, Ky., is one of the nation’s largest health care insurers in Medicare Advantage, a private policy that covers seniors and those with disabilities. Humana has been doing business in Minnesota for more than 10 years, and provides insurance coverage to more than 100,000 residents through various types of Humana Medicare Advantage plans, including a plan for prescription drugs, according to a company official.

Humana spokeswoman Kate Marx said in an e-mail that the insurer has not been notified of the complaint by the Minnesota attorney general’s office or by federal regulators.

“We take this very seriously and are working to identify the facts,” Marx said.

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Minnesota attorney general asks U.S. to investigate Humana

MN Attorney General Asks Feds To Investigate Humana

ST. PAUL, Minn. (WCCO) – Minnesota Attorney General Lori Swanson says a federal investigation is needed to look into business practices at one of the nation’s largest private Medicare insurers.

On Friday, Swanson sent a massive file of complaints against Humana to the federal agency charged with overseeing that part of Medicare.

She’s asking the Centers for Medicare & Medicaid Services (CMS) to look into more than 27 complaints on file.

For the past couple of years, Humana policy holders in Minnesota have complained of improper denial of coverage, overcharges for co-payments and failure to follow the required appeals process.

Kentucky-based Humana provides private Medicare insurance coverage to more than 100,000 Minnesota seniors.

This investigation into Humana’s alleged wrongdoing has been going on for a couple of years, Swanson asserts. It stems from both consumer and medical provider complaints from across the state.

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MN Attorney General Asks Feds To Investigate Humana


Minnesota Attorney General Lori Swanson today asked the federal agency responsible for regulating private Medicare insurance policies to investigate and remedy complaints by Minnesota senior citizens about improper claims handling by Humana, which sells private Medicare policies in Minnesota.

In a letter containing over 25 sworn affidavits from Minnesota patients and medical providers, Attorney General Swanson called on the federal Centers for Medicare & Medicaid Services (“CMS”), which regulates private Medicare plans, to investigate and remedy any violations of federal regulations arising from Humana’s improper claims handling in Minnesota. The United States Congress has determined that states are preempted from regulating benefit determinations of private Medicare Advantage plans and has vested jurisdiction to regulate such plans with CMS.

“Medical bills that aren’t covered or processed properly can hit senior citizens hard in the pocketbook. We are asking the federal agency that has authority over these plans to fully investigate and remedy the problems experienced by Minnesota patients,” said Swanson.

Medicare Advantage plans are private health plans approved by CMS, but sold and administered by private insurance companies as an alternative to traditional Medicare fee-for-service coverage. Medicare Advantage plans may provide prescription drug coverage and include mandatory or optional supplemental benefits such as vision and dental benefits. Minnesota has the highest number of enrollees in Medicare Advantage plans in the nation on a per capita basis, according to a June 2013 report by Kaiser Family Foundation.

In her letter, Attorney General Swanson cites numerous problems reported by Minnesota patients and providers about Humana, including:

  1. Denial of claims involving Medicare-covered services. (Other than hospice care, Medicare Advantage plans must cover anything traditional Medicare would cover.)
  2. Overcharges for co-payments and co-insurance.
  3. Failure to adequately disclose what providers are in network and to update its network provider directories.
  4. Failure to follow the appeal procedures required by federal regulations.

Humana is a publicly traded, for-profit insurance company. It is one of the biggest insurers in the Medicare Advantage market nationwide, offering at least one type of Medicare Advantage plan in all 50 states. About 17 percent of all Medicare beneficiaries nationwide are enrolled in a Humana Medicare Advantage plan, according to a June 2013 report by Kaiser Family Foundation.

The Attorney General’s Office provides this advice to Medicare beneficiaries who are thinking about enrolling in an Medicare Advantage plan:

  1. Determine if your health care providers are in-network.
  2. Identify the copays, deductibles, and out-of-pocket maximum costs for the plan. Plans’ costs will vary, especially for in- versus out-of-network care.
  3. Determine if supplemental benefits are offered by the plan.

People may report complaints against Humana to the Minnesota Attorney General’s Office by calling (651) 296 3353 or (800) 657 3787. Individuals may also download a Complaint Form from the Attorney General’s website by clicking here and mail the completed form to the Attorney General’s Office at: 1400 Bremer Tower, 445 Minnesota Street, St. Paul, MN 55101 2131. People should also contact CMS directly about this problem by calling CMS at 1-800-633-4227 or by writing to its Administrator, Marilyn Tavenner, at Centers for Medicare & Medicaid Services, U.S. Department of Health & Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, DC 20201.


Minnesota wants CMS to investigate Humana’s Medicare Advantage plans

AG Lori SwansonMinnesota Attorney General Lori Swanson is asking the CMS to investigate Medicare Advantage plans offered by Humana and has presented regulators with more than 25 affidavits of complaints from beneficiaries.

The affidavits allege, for instance, that Humana denied reimbursement for services that it is required to cover for all Medicare beneficiaries—including diagnostic ultrasounds, mammograms and care in a skilled-nursing facility for a stroke patient.

The letter also said, among other complaints, that the Louisville, Ky.-based insurer created confusion by not adequately disclosing which providers were in-network and does not comply with required appeals processes.

The complaints come at a time when the popularity of Medicare Advantage plans has been escalating. And Minnesota has the highest percentage of Medicare beneficiaries enrolled in an MA plan, at 49%—compared with 28.8% of beneficiaries nationwide, the letter said. Humana has 17% of the Medicare Advantage market in Minnesota, according to Swanson’s office.

Swanson wrote that she was asking the CMS to pursue an investigation because states do not have the authority to enforce Medicare Advantage plan rules and make benefit determinations.

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Minnesota wants CMS to investigate Humana’s Medicare Advantage plans