DaVita HealthCare Partners has been drawn into a federal investigation of Humana's Medicare Advantage risk-adjustment practices, DaVita said in a Securities and Exchange Commission filing Monday.
HHS' Office of Inspector General has subpoenaed JSA HealthCare Corp., a subsidiary of the HealthCare Partners division of DaVita, according to the SEC filing. The subpoena relates to an ongoing investigation into the risk-adjustment practices of Humana and its service providers, including how patient diagnoses were determined, according to the filing.
“Reports that physicians may have overbilled Medicare are upsetting, and if accurate, are contrary to the core values and practices of our company,” DaVita said in a statement Monday.
The statement notes that the scope of the inquiry mostly predates its 2012 acquisition of HealthCare Partners.
“We look forward to working with government officials and note that in the years since the acquisition of HealthCare Partners, significant compliance resources have been dedicated to reinforcing the compliance practices and standards of our organization."
The DaVita subpoena seeks documents and information for all Humana Medicare Advantage Plans for which JSA provided services from 2008 to 2013. It also seeks information on JSA's communications with Humana about patient diagnoses related to Humana's Advantage plans and two Florida doctors with whom JSA contracted.
The filing did not name the doctors.
The DaVita subpoena may be related to a U.S. Justice Department investigation that Humana disclosed in an SEC filing last month involving its Medicare Advantage risk-adjustment practices. The CMS pays Advantage plans partially based on patient risk scores, which reflect the health of patients. Sicker patients mean higher risk scores and higher payments to insurers. In recent years, some have accused plans of inflating risk scores to earn more cash.
Humana said in the February filing that it was told the probe was separate but related to a whistle-blower lawsuit filed in 2010, in which a doctor alleged Humana and one of its physician clinics knowingly submitted false claims to Medicare with inaccurate patient risk scores.