Humana Medicaid and Medicare Operations Under Investigation

Humana, Inc. has disclosed that some of its Florida subsidiaries are under investigation by the U.S. Department of Justice (DOJ) for possible Medicaid and Medicare fraud, according to Bloomberg.  Specifically, Humana revealed that the DOJ investigation involves the coding of Medicaid and Medicare claims and loans to physicians. Earlier this year, the U.S. Attorney’s Office in Miami asked Humana and its Florida subsidiaries to turn over information as part of the investigation.

Humana has also been conducting an internal investigation of certain practices of its Florida Medicaid and Medicare networks, such as loans to providers and enrollment practices. Announced last year, Humana says its internal investigation is ongoing, focusing on the relationships between Medicaid and Medicare providers and some of the company’s Florida employees as well as the financial support provided to nonprofit organizations and physician practices that enroll Medicare beneficiaries. Last year, Humana was fined $3.4 million by Florida regulators based on allegations that the company had not reported its suspicions of Medicaid fraud in a timely fashion, as reported by Fierce Health Payer. Humana has appealed the decision.

In addition, a whistleblower suit has been filed against Humana, Inc. that alleges the company violated a federal law prohibiting kickbacks.

Last year, 65 percent of Humana’s $36.8 billion in revenue came from providing medical and drug benefits to Medicare recipients, and 2.6 percent of the company’s revenue came from services to Medicaid beneficiaries.

Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.

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