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Feds investigating allegations that Humana overcharged Medicare
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Feds investigating allegations that Humana overcharged Medicare

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.

Humana spokesman Tom Noland said in an email on Thursday that the company had made "several public disclosures about these matters over a long period of time." He said that Humana had "self-reported" the matters to the Justice Department criminal division several years ago, but noted: "Humana to our knowledge is not the subject of any criminal investigation."

Noland added: "We continue to investigate these matters ourselves and to cooperate with the Department of Justice, as we have all along."

Humana, based in Louisville, Kentucky, is a major federal contractor. Last year, Humana's Medicare Advantage contracts in Florida alone covered about 415,200 seniors at a cost of $6 billion, according to the company. Nationwide, Humana treated just over 2 million Medicare Advantage patients last year.

The consequences of the legal cases could be far-reaching for privately run Medicare Advantage plans, which now treat nearly 16 million Americans at a cost expected to top $150 billion this year. The plans are proving popular with seniors because they often provide extra benefits, such as eyeglasses and dental care, and can cost less out of pocket than standard Medicare.

Reprinted by permission of The Center for Public Integrity.

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