A Kentucky judge has ruled that Louisville-based Humana, a major healthcare insurance company that contracts with Medicare to provide Medicare Part D Prescription Drug Plans, must pay law firm Phillips & Cohen LLP $32 million in attorney fees more than a year after reaching a groundbreaking $90 million settlement of a federal False Claims Act whistleblower lawsuit.
Whistleblower Steven Scott, a former Humana actuary, filed the lawsuit in 2016, alleging that Humana was inflating its costs between 2011 and 2017 to get favorable bids with the Centers for Medicare & Medicaid Services (CMS), even though the insurer was providing below the required level of coverage—ultimately leading to substantial overcharges to the government.
Humana pocketed the difference as profit, which amounted to hundreds of millions of dollars, according to Scott’s suit.
Scott also alleged that Humana maintained two sets of books to perpetuate the scheme, a practice that ended in 2017 once the government began investigating the case. The U.S. Department of Justice (DOJ) later declined to intervene.
Scott was a Managing Actuary for the insurer at the time he filed the qui tam lawsuit. As stated in the complaint, he was an insider “with responsibility for modeling the cost of Humana’s Medicare health insurance benefits under different actuarial assumptions.”
Humana is required to cover the fees, even as a looming appellate challenge raises questions about the future of whistleblower litigation...
Your support helps us to tell the story From reproductive rights to climate change to Big Tech, The Independent is on the ground when the story is developing. Whether it's investigating the financi...