Managed-care provider Humana is in the process of determining whether to appeal a $3.4 million fine from the Florida Bureau of Medicaid Program Integrity for not reporting suspected instances of fraud quickly enough.
Humana mulls next move after receiving Fla. fine
In two letters last week, Florida Office of Inspector General Bureau Chief Mike Blackburn informed the insurer that the Agency for Health Care Administration (PDF) had slapped the Louisville, Ky.-based firm with civil monetary penalties of $660,400 and $2.7 million for alleged failures to report instances of suspected fraud to state officials.
Humana, a large Medicaid managed-care provider in the state, did self-report the suspected frauds, but the state officials said the alleged instances happened as long ago as Sept. 1, 2009. Humana’s contract required the insurer to report suspected wrong-doing within 15 days of detection, with fines ranging between $200 and $1,000 per day for failure to report, the fine letters say.
Humana spokesman Mitchell Lubitz said in an e-mailed statement that the company is reviewing the letters, “which relate to Humana’s timely reporting as required by our Florida Medicaid contract.” A decision on whether to appeal the fine had not yet been made.
Humana officials would not comment on what fraud was suspected. However, the company disclosed in an Aug. 1 filing with the Securities and Exchange Commission that it had reported to state and federal officials that it was investigating relationships between Humana employees and Medicaid providers, financial support of centers that provide Medicaid enrollment access, and loans or financial support to physicians.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.