Medicare Advantage Fraud Is Rampant: Humana Under Investigation

17 Jun Medicare Advantage Fraud Is Rampant: Humana Under Investigation

Medicare Advantage Fraud Is Rampant: Humana Under Investigation

Humana is one of the largest and well know Medicare Advantage insurers. Medicare Advantage plans across the board have been the target of multiple government investigations. The whole Medicare Advantage program is a taxpayer money loser. If you add up the government’s over payment for the plans to companies and the fraud that is that has been going on for years, it a losing proposition for the consumers and the taxpayers.

Here is an example: Humana Inc. health plan for seniors in Florida improperly collected nearly $200 million in 2015 by overstating how sick some patients were. According to a new federal audit, which seeks to claw back the money.

Overstating how sick patients are has to be a coordinated effort within the company and from the actual providers in some cases. Basically, it would be considered organized fraud.

The Health and Human Services Office of Inspector General’s recommendation to repay, if finalized, would be “by far the largest” audit penalty ever imposed on a Medicare Advantage company. Christopher Bresette, an HHS assistant regional inspector general says:  “This [money] needs to come back to the federal government.”

Humana sharply disputed the findings of the audit, which was set for public release Tuesday. A spokesman for the company said Humana will work with Medicare officials “to resolve this review” and noted that the recommendations “do not represent final determinations, and Humana will have the right to appeal.”

While popular with seniors, Medicare Advantage has been the target of multiple government investigations. Department of Justice and whistleblower lawsuits and Medicare audits that concluded that some plans boosted their government payments by exaggerating the severity of illnesses they treated.

One 2020 report estimated that improper payments to the plans topped $16 billion the previous year.

This is a serious problem; I think that Medicare Advantage plans should be shut down and let Medicare take over the Medicare beneficiaries’ coverage from here forward.

Buzz Stone

The Medicare Buzz

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