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Humana says it's not alone in DOJ investigation of Medicare Advantage billing

Medicare Advantage issues go back several years, the Center for Public Integrity Found

Humana said this week that a Department of Justice (DOJ) investigation into risk adjustments assigned to Medicare Advantage beneficiaries is part of a more extensive review that involves other healthcare companies, reported Reuters.

"Humana believes that this request for information is in connection with a wider review of Medicare Risk Adjustment generally that includes a number of Medicare Advantage plans, providers and vendors. The Company continues to cooperate with and voluntarily respond to the request for information," the insurer stated in a regulatory filing.

Humana's disclosure comes on the heels of a recent report from the DOJ and Department of Health and Human Services which found that the Health Care and Abuse Control Program recovered $3.3 billion of taxpayer money in 2014 fiscal year alone. Approximately $1.9 billion was transferred to the Medicare Trust Funds and another $523 million to the Treasury.

The Obama administration went to great lengths to proclaim how it plans to crack down on potential healthcare providers suspected of Medicare fraud. What was left out of these announcements, however, was a plan for addressing health insurance companies, reported the Center for Public Integrity (CPI). "Improper payments" to Medicare Advantage plans may exceed $12 billion in 2014 alone, CPI found. 

CPI referenced a 2009 report as evidence that the administration is, perhaps, purposefully leaving insurers out of the equation. At the time, the report shed light on improper billing practices plaguing the Medicare Advantage program. However, the administration never released an official announcement regarding the report.

CPI learned from the Centers for Medicare & Medicaid Services that the report was too long to be made public. However, CPI noted that the report appeared in 2009--the year heated debate began surrounding the Affordable Care Act. For the ACA to work, the administration needed the support of insurers.

The Humana investigation, for its part, involves payments allegedly made form 2008 to 2013. "As matter of policy, the department generally neither confirms nor denies the existence of an investigation," DOJ spokeswoman Nicole Navas told Retuers. 

For more:
- here's the Reuters article
- check out the Humana filing
- read the CPI story

Related Articles:
DOJ investigating Humana's Medicare Advantage billing process
Amid billions in recoveries, Medicare Advantage problems still linger
DOJ-HHS anti-fraud effort recovered $3.3 billion in 2014