Classified in: Health, Business
Subject: LAW
SAN FRANCISCO, Aug. 16, 2024 /PRNewswire/ -- Humana, a healthcare insurance company that contracts with Medicare to provide Medicare Part D Prescription Drug Plans, agreed to pay $90 million to the federal government to settle a whistleblower lawsuit filed by Phillips & Cohen LLP under the False Claims Act. The lawsuit alleges that Humana submitted fraudulent bids to the Centers for Medicare & Medicaid Services (CMS) for lucrative Medicare Part D prescription drug contracts from 2011-2017, significantly overcharging the government. This is first case of its kind to resolve allegations of fraud in the Part D contracting process.
Medicare Part D is the Government's voluntary prescription drug program under which CMS contracts with private insurance companies to cover prescription drug benefits for people enrolled in Medicare. By law, the insurance companies must offer plans that cover a minimum required portion of drug costs, with the government and Medicare beneficiaries covering the rest. CMS requires insurance companies to submit annual bids in which they report the benefits they propose to cover and confirm that those benefits meet Part D's minimum coverage level. The complaint in this case alleged that Humana committed to providing the required level of coverage, but in fact planned to provide less, with the government and beneficiaries unknowingly picking up more than their share.
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