Feds investigating allegations that Humana Inc. overcharged Medicare Advantage program

The entrance to the Humana headquarters in Louisville, Kentucky. Brian Bohannon/AP

The entrance to the Humana headquarters in Louisville, Kentucky.
Brian Bohannon/AP

Giant health insurer Humana Inc. faces multiple federal investigations into allegations that it overbilled the government for treating elderly patients enrolled in its Medicare Advantage plans, court records reveal.

The status of the investigations is not clear, but they apparently involve several branches of the Justice Department. The U.S. Attorney’s Office in Miami wrote in a court document filed in March that officials expect that at least one of the probes will be completed and the findings made public “in the next few months.”

The U.S. Attorney’s branch office in West Palm Beach, Florida has opened a criminal case involving overbilling allegations that the government says is similar to the Miami investigation. Meanwhile, the criminal division of the Justice Department in Washington has reviewed fraud allegations against the company, according to court records.

Humana, which insures more than 2 million people through the Medicare Advantage plans, is also the target of two Florida whistleblower civil lawsuits that allege similar overcharges.

Federal officials disclosed their legal actions in a series of documents unsealed April 30 in one of the whistleblower suits. That suit alleges that a doctor at a clinic in South Florida inflated billings for two dozen or more Humana patients. The case, filed in September of 2010, was unsealed in federal court in Miami earlier this month. The whistleblower added new allegations of overbilling to the Miami lawsuit on Wednesday.

Humana acknowledged the unsealing of the Miami case in a May 7 Securities and Exchange Commission filing, saying it “was continuing to cooperate with and respond to information requests from the U.S. Attorney’s Office.” Humana disclosed in 2012 SEC filings that federal officials were seeking documents “relating to several matters including the coding of medical claims,” an admission that was reported at the time. But the company has offered no details.

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Feds investigating allegations that Humana Inc. overcharged Medicare Advantage program

Missouri regulators lead multistate, market conduct investigation of Humana

Humana Insurance agrees to $4.5 million settlement and change in business practices

Jefferson City, Mo. – The Missouri Department of Insurance today announced that a regulatory settlement agreement has been reached with Humana Insurance Co. Missouri regulators led a multistate market conduct investigation of Humana in collaboration with regulators in Mississippi and Wisconsin. In the settlement, Humana agrees to pay $1.8 million in fines that will be divided among 10 states and to establish a $2.7 million consumer restitution pool.

The multistate market conduct investigation of the company began in 2012. The investigation was based upon a referral of a single complaint that was filed by a small employer with the Missouri department’s consumer affairs division. The investigation found that Humana Insurance Company was requiring some employers, who purchased small group medical insurance, to also purchase a group life insurance product. In the settlement, Humana agreed to make business reforms to include notifying employers and insurance agents that the additional purchase of life insurance is not required. Humana also agreed to set up a $2.7 million restitution pool to provide refunds for employers who were required to purchase the group life product.

“Policyholders should be able to choose individual insurance products without insurers bundling products together” said Missouri Insurance Director John M. Huff. “I am pleased our team was able to collaborate on a settlement with multiple states to benefit consumers.”

Missouri will receive $390,886, paid to the Missouri State School fund. Other states that will benefit from the settlement and fine are Alabama, Arkansas, Georgia, Mississippi, Montana, North Carolina, Tennessee, Utah and Virginia.

In market conduct exams and investigations, the Department of Insurance reviews insurance company practices regarding the treatment of policyholders. This includes the way premium rates are charged, the way insurers handle claims and other responsibilities under state law. These reviews can result in refunds for consumers, fines and corrections in business practices, as well as other remedies. In the last five years, Market Conduct enforcement actions have generated nearly $20 million in payments from insurance companies. The money goes toward refunds for consumers, general revenue and the Missouri State School Fund.

Consumers who have complaints or questions about life and other types of insurance, can call the department’s Insurance Consumer Hotline at 800-726-7390 or by visiting insurance.mo.gov.

About the Missouri Department of Insurance, Financial Institutions & Professional Registration

The Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP) is responsible for consumer protection through the regulation of financial industries and professionals. The department’s seven divisions work to enforce state regulations both efficiently and effectively while encouraging a competitive environment for industries and professions to ensure consumers have access to quality products.


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Missouri regulators lead multistate, market conduct investigation of Humana

Insurance Giant Abruptly Withdraws Cheaper Plan

Get Gephardt ABoT(KUTV) Natasha Sponbeck runs a small business called Zap Electric. Natasha says the company has always offered health insurance to its employees.

“That is a great benefit to recruit people,” she said. “They want to go work somewhere where they get benefits.”

Zap Electric’s coverage has been through Humana. Natasha says she was concerned about changes coming because of the Affordable Care Act until she got a letter in the mail.

“I got a letter from Humana stating I could keep my grandfathered plan,” she said.

Natasha agreed. But week later, her insurance agent discovered Humana has already switched Zap Electric over to a new, Affordable Care Act approved plan. The new plan will cost roughly $12-thousand more per year.

“It’s a lot more money for way worse coverage,” Natasha said.

Natasha contacted Humana to complain, and was sent an email that said, “…there has been a lot of miscommunication and errors in letters.”

And the email says, indeed “Zap Electric is going to have to change to an [Affordable Care Act] compliant plan.”

But Natasha suspects that the miscommunication may have been deliberate. She says that if she hadn’t been proactive she would not have discovered the error before the bills went up.

“If this was a mistake, why have they not sent all of us letters letting us know this is a mistake?” she asked.

Natasha says she tried to work out a deal with Humana but the insurance giant wouldn’t budge.

Natasha turned to the Utah Department of Insurance to file a complaint but she cannot get a return call.

Frustrated and not wanting to pay for the more expensive plan, she decided to Get Gephardt.

Get Gephardt began our investigation with the Affordable Care Act signed into law nearly four years ago. In the act we found a paragraph that talks about modifications to plans. It says that if a change is made to a plan then the insurance company has to “provide notice” to the customer. The act also says the insurance provider must give a 60 days notice of such changes so the customer can to decide if they want to stay or go.

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Insurance Giant Abruptly Withdraws Cheaper Plan

Humana Used Obamacare as Club Against Policyholders, Class Claims

KANSAS CITY, Mo. (CN) – A federal class action claims Humana jacked up its health insurance premiums to coincide with Obamacare, while failing to give policy holders a reasonable way to cancel policies.

Lead plaintiff Daniel L. Doyle sued Kentucky-based Humana on Tuesday.

Doyle says he received a letter from Humana in August stating that his policy would be canceled on Dec. 31, 2013 and replaced with a new one, to coincide with the Affordable Health Care Act.

The premium for the new policy would be $395.97 a month, significantly (73%) higher than the $229.30 a month Doyle had been paying.

Doyle says he received another letter on Oct. 24, 2013 with clarification to the August letter. He then found a better policy with another provider and wanted to cancel his policy with Humana.

“On or about November 20, 2013, Mr. Doyle was notified that he had new insurance coverage with Blue Cross Blue Shield beginning December 1, 2013,” the complaint states.

“Plaintiff then immediately attempted to contact Humana to cancel his policy but was unable to reach anyone who could assist him to cancel.

“Plaintiff again tried to cancel two to three days later. He again was unable to reach anyone at Humana who could assist him in cancelling his policy.

“On numerous occasions, Mr. Doyle unsuccessfully attempted to cancel his policy by calling the toll-free number listed in the October 24, 2013 letter. Whenever Mr. Doyle called the toll-free number, he encountered an automated call system that would not enable him to speak to a person.

“Frustrated with the significant hold times and inability to speak with a human being, Mr. Doyle contacted his Blue Cross representative, who provided a fax number for Humana which he was unable to locate on Humana’s website.

“On or about November 25, 2013, Mr. Doyle sent a facsimile to Humana providing Human with written cancellation of his policy.

“Humana refused to respond to Mr. Doyle’s written cancellation request.

“On or about January 7, 2014, Mr. Doyle sent a letter to Humana enclosing his November 25, 2013 cancellation request. The letter also demanded that Humana stop deducting the premium from Mr. Doyle’s checking account and return money taken by Humana after Mr. Doyle’s cancellation request.

“Humana refused to respond to Mr. Doyle’s January 7, 2014 letter.

“Plaintiff continued his attempts to call Humana several more times. On or about January 10, 2014, plaintiff was, for the first time, able to speak with an individual after waiting for approximately 20 minutes. But after getting through to a representative, the representative informed plaintiff that the representative did not have the authority to cancel plaintiff’s policy.”

The class consists of all Humana policyholders in the United States who have been billed for insurance premiums on policies which were canceled by Humana on or before Dec. 31, 2013 and/or after the class member tried to cancel the policy.

Doyle seeks class certification, wants Humana enjoined from continuing its practices, disgorgement of profits from the scheme and actual and punitive damages for violations of the Kentucky Consumer Protection Act.

He is represented by Eric L. Dirks with Williams Dirks.

Humana is one of the largest health insurers in the country, with more than $13 billion in revenue in 2013, according to the lawsuit.

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Humana Used Obamacare as Club Against Policyholders, Class Claims

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

Humana Sued in Federal Court Over Incentives for Doctors

Humana Inc., one of the nation’s largest managed-care companies, was accused in a Federal lawsuit yesterday of misleading health plan members by failing to disclose financial incentives to doctors and case reviewers intended to keep down costs by limiting or denying care.

The suit, filed on behalf of workers in Florida and Texas, asked a United States District Court in Miami to certify a class action on behalf of more than six million customers of Humana health plans nationwide. The suit seeks triple damages under the Federal anti-racketeering law. No amounts were specified.

The plaintiffs say they did not get the health coverage that they thought they were selecting because the company did not disclose incentives to doctors to deny care.

Joseph Sellers, a Washington lawyer who represents the plaintiffs in Miami, said the suit did not question whether managed care was a good idea or whether cost should be a factor. Instead, the suit contends that there was a ”breach of trust” because plan members thought that medical guidelines would solely determine their treatment.

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Humana Sued in Federal Court Over Incentives for Doctors