Tag Archives: Humana

Feds investigating allegations that Humana Inc. overcharged Medicare Advantage program

by

0

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.

Full Article & Source & to Continue Reading:
Feds investigating allegations that Humana Inc. overcharged Medicare Advantage program

Medicare Advantage plans to pay Central Ohio Primary Care to keep patients out of hospital

by

0

Advantage Plans title5The largest independent physician group in Central Ohio will get bonus payments for keeping the frailest patients well and out of the hospital under a new deal with five private Medicare Advantage plans.

Central Ohio Primary Care Physicians Inc. will get a fixed monthly payment for patients in the pilot program, plus a share of the savings from actuarial estimates of that group’s 2014 medical expenses. The plans also have agreed to pay for sending patients directly to a high-acuity wing of a skilled nursing facility without the usual requirement for a three-day hospital stay.

The average hospital stay costs at least $10,000, said Dr. William Wulf, CEO of the 270-doctor group. The practice’s hospitalists – specialists who follow patients through inpatient stays – say about one-fourth of patients admitted could have been cared for in a less-costly setting, but regulations and existing payment incentives encourage the hospitalization.

“What if that hospitalist was in a shared savings program for that $10,000?” Wulf said. “That’s where we need to go, that’s where we’re going with population health.”

Full Article & Source:
Medicare Advantage plans to pay Central Ohio Primary Care to keep patients out of hospital

Missouri regulators lead multistate, market conduct investigation of Humana

by

0

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.

###

Full Article, Press Release & Source:
Missouri regulators lead multistate, market conduct investigation of Humana

Humana to pay $1.8 million fine

by

0

February 14, 2014 4:38 pm

Humana Insurance Co. has agreed to pay $1.8 million in fines and $2.7 million in restitution to Missouri and other states resolve complaints about its sale of small group health insurance.

The Missouri Department of Insurance alleged that Humana required small employers to buy group life insurance in order to get small group health coverage. Such bundling violates insurance regulations. Ten states will divide the fine. Missouri regulators led the investigation with regulators from Wisconsin and Mississippi.

Full Article & Source:
Humana to pay $1.8 million fine

Former Marine now battling Medicare for life-saving surgery

by

0

Robert Zurheide asking if they are waiting for him to dieTUCSON- A Tucson man and former Marine says his life is in limbo, caught between the need for life-saving surgery and a Medicare Advantage plan that will not cover the procedure. Robert Zurheide went on disability after he was injured in 2002 while working as a corrections officer in Florence. He has been battling chronic pancreatitis for nearly three years and says doctors at UAMC recommended a pancreas transplant as soon as possible. That was more than eight months ago.

“I love my country to the core, it’s in the core of me,” said Zurheide.

Military service is more than a passion for the Zurheide family, it is a way of life. Robert’s son Graham is a 1st Lieutenant in the Marines and his younger son has plans to join. However it is a tradition that claimed the life of Zurheide’s oldest son, 20-year-old Robert Zurheide Jr., who was killed while serving in Iraq in 2004.

“He came over, he gave me that big hug and he went back around to the car, got in and they drove off, and I never saw him again,” Zurheide said.

Nearly ten years after his son’s death, Zurheide says he is now fighting for his own life. He spends hours, even days in the hospital as his pancreas continues to fail.

“Worst pain I’ve ever felt in my life, and it could kill me,” he said.

Full Article, Video & Source:
Former Marine now battling Medicare for life-saving surgery

Insurance Giant Abruptly Withdraws Cheaper Plan

by

0

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.

Full Article, Video & Source:
Insurance Giant Abruptly Withdraws Cheaper Plan