In the South Florida case, government lawyers have been investigating Humana, Inc. for several years as they try to determine if the company and some of its medical clinics manipulated the complex Medicare Advantage billing system. Humana says it is cooperating with the investigation.
Humana also faces other investigations into allegations that it overbilled the government, including a criminal investigation by the Department of Justice in Washington and a criminal case involving the U.S. Attorney’s branch office in West Palm Beach, Florida, according to court records. Humana spokesman Tom Noland said, “Our original self-disclosure several years ago was made to the criminal division of the Department of Justice, but Humana to our knowledge is not the subject of a criminal investigation.”
Medicare Advantage is a “black box,” added James Cosgrove, who heads health investigations for the GAO, the audit arm of Congress.
“We know what services they say they will provide … but we never know exactly what services are being provided,” Cosgrove said.
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Medicare Advantage billing errors cost taxpayers billions