Skip to main content

Humana Settles Medicare Fraud Case for $90 Million

Humana Settles Medicare Fraud Case for $90 Million

Humana Settles Medicare Fraud Case for $90 Million

Introduction

Louisville-based Humana has agreed to pay $90 million to settle a whistleblower lawsuit alleging Medicare drug fraud under the False Claims Act.

The lawsuit, filed in California, accused the healthcare company of submitting fraudulent bids to the Centers for Medicare & Medicaid Services (CMS) for Medicare Part D prescription drug contracts between 2011 and 2017.

According to the lawsuit, Humana significantly overcharged the federal government by using two sets of financial records—one for its bids to CMS and another for internal purposes, which accurately reflected the company’s actual anticipated costs. The whistleblower, a former Humana actuary, claimed the company knowingly based its bids on inflated numbers that consistently favored Humana by hundreds of millions of dollars. This scheme allegedly affected the company’s Part D "Walmart Plan."

Demand letter free trialThe whistleblower lawsuit, filed in 2016, also claimed Humana adjusted its practices after the government launched an investigation in 2017. The case was settled just before going to trial, marking the first resolution of fraud allegations related to the Part D contracting process.

The attorney representing the whistleblower stated that Humana's actuaries had prepared different financial predictions for its internal use and the government’s bidding process. Humana has not admitted liability in the settlement but agreed to the payout to resolve the claims.

Comments
  • Allowed HTML tags: <a href hreflang> <em> <strong> <cite> <blockquote cite> <code> <ul type> <ol start type> <li> <dl> <dt> <dd> <h2 id> <h3 id> <h4 id> <h5 id> <h6 id>
  • Lines and paragraphs break automatically.
  • Web page addresses and email addresses turn into links automatically.

Latest Personal Injury News

Jury Rules Norfolk Southern Must Pay $600M Settlement

Categories: Settlements

The company that owned the railcar involved in the 2023 East Palestine, Ohio train derailment will not be held financially responsible for the $600 million class-action settlement Norfolk Southern agreed to pay residents.

An Ohio jury ruled…

Veteran Receives $10.6M Verdict for Motorcycle Crash

Categories: Verdicts

A Volusia County motorcycle rider who was seriously injured in a Daytona Beach Shores crash has been awarded a $10.6 million verdict by a jury. 

This came after the rider rejected a settlement offer of just $90,000. The jury determined that…

Widow Wins $1.3M in Veteran's Medical Malpractice Case

Categories: Settlements

A woman from Buxton has been awarded $1.3 million by a U.S. District Court judge after filing a medical malpractice lawsuit against the federal government on behalf of her late husband.

The case stems from the mistreatment of her 69-year-…