Humana sued a Florda-based telemedicine company and several physicians for posing at insurer representatives and running a prescription drug scheme that allegedly cost Humana millions of dollars.
Boca Raton, Fla-based QuivvyTech, Reliable Document Solutions, Reliable Medical Supplies and six doctors allegedly ran an "organized, elaborate telemedicine scheme" where they cold-called Humana plan members and asked them questions about their health. Humana also listed eight pharmacies in the federal lawsuit as co-conspirators, but did not sue them.
The telemarketers allegedly encouraged patients to talk about conditions commonly treated with antifungal medications. Telemarketers then wired that information to a set of physicians contracted by QuivvyTech, who electronically prescribed medications—often high-cost topical creams—without having spoken with the patient directly, according to the complaint.
QuivvyTech allegedly paid the physicians for visits with Humana members, even though the visits had not occurred, and in some cases billed Humana members for the supposed visit. Physicians involved with the scheme allegedly attested to false statements when prescribing medications, claiming they had a prescriber-patient relationship with the member.
The allegedly fraudulent prescriptions were wired to a set of pharmacies that had paid to participate in the scheme. The pharmacies would bill Humana for the claims, according to the complaint.
"In turn, Humana members often were left confused, irate and in the possession of unwanted expensive creams," the complaint reads.
Humana members were allegedly told the medications would be at no cost to them, but would later receive invoices for QuivvyTech telehealth consultations, according to the complaint.
Humana paid the pharmaceutical claims through wire transfers while "unaware of the scheme," according to the complaint. To date, Humana has identified more than 200 members who have said they either did not request or did not receive prescriptions that were billed to Humana as part of the alleged scheme.
Humana accused the defendants of violating federal and Florida criminal and civil laws, including wire fraud, mail fraud and laws governing telehealth for Medicare patients.
"The damages incurred by plaintiffs were the direct and natural consequence of the pattern of racketeering activity involving the fraudulent QuivvyTech prescriptions," the complaint reads.
Humana did not immediately respond to a request for comment. QuivvyTech said it referred Modern Healthcare's request for comment to its counsel.
The lawsuit is filed in the midst of healthcare groups pushing for many COVID-19 telemedicine flexibilities to remain intact after the pandemic subsides. Regulators including CMS Administrator Seema Verma have voiced support for expanding telemedicine coverage, but also cautioned that the industry needs to figure out how to root out possible fraud.