Humana settlement overview:ย
- Who: Health insurance company Humana agreed to pay $90 million to the federal government.
- Why: The settlement ends claims Humana submitted fraudulent bids for Medicare contracts.
- Where: The Humana settlement was lodged in a Kentucky federal court.
Health insurance company Humana agreed to pay a $90 million settlement to the federal government to end claims it submitted fraudulent bids for Medicare contracts.
A press release by attorneys for the plaintiffs, Phillips & Cohen LLP, announced the settlement Aug. 16.
โThis is the first case of its kind to resolve allegations of fraud in the Part D contracting process,โ the firm says in the release.
Humana contracts with Medicare to provide Medicare Part D Prescription Drug Plans.
According to the plaintiffs, Humana submitted fraudulent bids to the Centers for Medicare & Medicaid Services for lucrative Part D prescription drug contracts from 2011-2017, significantly overcharging the government.ย ย
Medicare Part D is the governmentโs voluntary prescription drug program under which CMS contracts with private insurance companies to cover prescription drug benefits for people enrolled in Medicare.ย ย
By law, the insurance companies must offer plans that cover a minimum required portion of drug costs, with the government and Medicare beneficiaries covering the rest, the lawsuit claimed.ย
CMS requires insurance companies to submit annual bids in which they report the benefits they propose to cover and confirm those benefits meet Part Dโs minimum coverage level. The complaint alleged Humana committed to providing the required level of coverage yet planned to provide less, with the government and beneficiaries unknowingly picking up more than their share.
โThe Part D program depends on insurance companies paying their minimum share of drug costs,โ Claire Sylvia, a whistleblower attorney and Phillips & Cohen partner who filed the case, says in the press release. โWe argued that Humana shirked its responsibility by telling the government that its plan would cover drug costs that Humana did not actually plan to cover.โย ย
She says the complaint detailed how the government and beneficiaries were left paying tens of millions of dollars more than Congress intended for years while Humana pocketed the money as savings.
Human kept two sets of books during scheme, lawsuit claims
The complaint alleged Humana kept two sets of books โ one set its actuaries prepared for bids Humana submitted to the government and a separate internal set Humanaโs actuaries prepared with Humanaโs actual anticipated costs, which the company used for all its business dealings, including its internal budgeting.ย
Steven Scott, the whistleblower who filed the lawsuit in 2016, is a former actuary for Humana.ย ย
The complaint alleged he discovered Humana had accurately predicted internally each year the costs for its Part D Walmart Plan while basing its bids to the government on different and unsupported assumptions used for no other purpose.ย ย
In 2023, a consumer hit Humana with a class action lawsuit alleging it unlawfully deploys artificial intelligence to wrongfully deny elderly patients care owed to them under Medicare Advantage plans.
What do you think of this Humana settlement? Let us know in the comments!ย
Scott is represented by Andrew C. Shen, James M. Webster III, Bethan R. Jones, Katherine C. Cooper, Caroline Schechinger and Thomas G. Schultz of Kellogg Hansen Todd Figel & Frederick PLLC and Claire M. Sylvia, Edward Arens and George Collins of Phillips & Cohen LLP.ย
The Humana Medicare settlement is United States of America et al. v. Humana Inc., Case No. 3:18-cv-00061, in the U.S. District Court for the Western District of Kentucky.
Donโt Miss Out!
Check out our list of Class Action Lawsuits and Class Action Settlements you may qualify to join!
Read About More Class Action Lawsuits & Class Action Settlements:
54 thoughts onHumana to pay $90M to settle fraudulent Medicare bid lawsuit
Add me
Add me
Humana is what I carry. If they have done me wrong, then I would love to know please. I have had them for approximately 4 years give it take a month. Thank you
My husband has has them for years. Add us
Iโve had Humana since 1/1/2024 and I can honestly say that they have been GREAT. Iโve received everything I told I would get and then some. To many opportunist try to jump on the band wagon when they loss nothing and already got more than they should. I will stick with Humana and tell anyone that itโs the best. So people need to be honest and not become fraudulent gold diggers with their lies.
Add me Iโve been paying thousands with prior authorizations and still declined
I have been paying to much for my prescription
Oh my Iโve had them for years! Add me too please
Wow did you NOT READ THE ARTICLE???? This isnโt for US Humana to pay that amount to THE GOVERNMENT which I think is BS bc we had to pay money on our medicine we shouldnโt have. If there was something for us then there would be a claim button
Nef my money
Add me please
Add me
Add me