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About POGO's Federal Contractor Misconduct Database (FCMD)
The government awards contracts to companies with histories of misconduct such as contract fraud and environmental, ethics, and labor violations. In the absence of a centralized federal database listing instances of misconduct, the Project On Government Oversight (POGO) is providing such data. We believe that it will lead to improved contracting decisions and public access to information about how the government spends hundreds of billions of taxpayer money each year on goods and services. Report an instance of misconduct »
Ranking: 16
Humana
Humana Inc., headquartered in Louisville, Ky., is one of the nation's largest publicly traded health benefits companies, with approximately 9 million medical members. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals
Federal Contract $: $3445.3m
Total Number of Instances: 13
Total Misconduct dollar amount: $ 133.4m
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Instances of Misconduct
1. Academy of Medicine of Cincinnati v. Humana Health Plan of Ohio Inc. (Antitrust)
“The Academy of Medicine of Cincinnati, the Butler County Medical Society, the Northern Kentucky Medical Society, and several physicians filed antitrust suits in state courts in Ohio and Kentucky against Aetna Health, Inc., Humana Health Plan of Ohio, Inc., Anthem Blue Cross Blue Shield, and United Healthcare of Ohio, Inc., alleging that the defendants violated the Ohio and Kentucky antitrust laws by conspiring to fix the reimbursement rates paid to physicians in the Greater Cincinnati and Northern Kentucky region. Each suit sought class certification, damages and injunctive relief. Plaintiffs cited no evidence that any such conspiracy existed, but based their allegations on assertions that physicians in the Greater Cincinnati region are paid less than physicians in other major cities in Ohio and Kentucky. On October 23, 2003, [Humana] entered into a settlement agreement with the plaintiffs that specified an increase in future reimbursement we pay to a class consisting of physicians in a 12-county area in Southern Ohio and Northern Kentucky over the next three years. [Humana] agreed to increase the reimbursement, in the aggregate, subject to certain contingencies, that will increase the amounts paid for physician services over the amounts paid in 2003 as follows: $20 million in 2004, an additional $15 million in 2005 and an additional $10 million in 2006. The agreement also provides for a committee to monitor our contracting practices for the period 2007 through 2010, with reporting to us if any anticompetitive behavior is believed to have occurred. The agreement was approved by the courts on December 30, 2003.” Altogether, by calendar year 2006, the total reimbursement Humana agreed to pay would amount to at least $100 million greater than if reimbursement during that time were paid at 2003 levels. Humana also agreed to pay plaintiffs' attorney fees in the amount of $6 million.... more»
2. Conspiracy to Improperly Deny, Delay and/or Reduce Physician Payments
“This action is between (1) a class of practicing or retired physicians from around the United States and by certain medical societies, and (2) a number of health care insurance companies, including Aetna, Anthem, Inc., Cigna, Coventry Health Care, Inc., Health Net, Inc., Humana Health Plan, Inc., Humana, Inc., Pacificare Health Systems, Inc., Prudential Insurance Company of America, United Health Care, United Health Group and Wellpoint Health Networks, Inc. The complaint in the Action alleges that between 1990 and 2002, these companies engaged in a conspiracy to improperly deny, delay and/or reduce payment to physicians by engaging in several types of allegedly improper conduct... The complaint claims that this conduct violated various state and federal statutes. The named plaintiffs in the complaint also seek recovery on various common law theories, including breach of contract.” In August 2006, Humana settled claims filed on behalf of a class consisting of chiropractors and other non-MD specialists, agreeing to pay $3.5 million and change its business practices.... more»
3. Physician Corporation of America Securities Litigation (False Statements)
“The consolidated complaint alleged that [Humana subsidiary, Physician Corporation of America (PCA)] and the individual defendants knowingly or recklessly made false and misleading statements in press releases and public filings with respect to the financial and regulatory difficulties of PCA’s workers’ compensation business… On August 25, 2003, the parties entered into an agreement to settle the case for the amount of $10.2 million. On November 26, 2003, the settlement received final approval by the Court.”... more»
4. Failure to Provide Accurate Beneficiary Information
The Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) imposed a civil penalty of $55,880 on Humana Insurance Company for failing to provide accurate information to Medicare beneficiaries in Contract Year 2010 Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents. CMS determined that 5,588 Humana members received ANOC/EOC materials containing an incorrect statement regarding prescription drug coverage.... more»
5. Colorado Insurance Violations
The Colorado Division of Insurance fined Humana Insurance Company $191,500 and Humana Health Plan, Inc. $122,500 for violations of Colorado insurance laws. The violations, discovered in market conduct examinations covering the time period July 1, 2007 to June 30, 2009, included missing or incorrect information provided in policy forms, using rates not filed with the Division of Insurance, failing to pay claims within time frames required by Colorado law, using incorrect utilization review procedures, and failing to use correct procedures when terminating coverage.... more»
6. Violations of the Fair Labor Standards Act
Humana agreed to pay $1,013,259 to 2,510 employees for violations of the Fair Labor Standards Act. According to the Labor Department, between February 2003 and February 2005, Humana failed to properly compensate customer service and claim specialists at call centers in Cincinnati, Louisville, and Green Bay who performed various off-the-clock tasks.... more»
7. Unsupported Price Increases
In one of a series of reports on Medicare+Choice organizations’ use of the additional funding provided by the Benefits Improvement and Protection Act of 2000 (BIPA), the Department of Health and Human Services sought to "determine whether Humana (1) supported the $7.8 million of additional capitation payments and used the funds in a manner consistent with BIPA requirements and (2) supported the $6.6 million cost increase that was not related to the BIPA funding increase. Of the $7.8 million BIPA capitation payment increase in Humana’s revised proposal, $2.6 million was properly supported and was used in a manner consistent with BIPA requirements. However, the remaining $5.2 million was unsupported; therefore, we could not determine whether it was used in a manner consistent with BIPA requirements. Additionally, of the $6.6 million increase in direct medical care costs that was not related to the BIPA funding increase, $1.3 million was supported. The remaining $5.3 million was unsupported.”... more»
8. Wrongful Death
A San Antonio, Texas jury awarded $7.4 million in actual damages in a wrongful death lawsuit against Humana Health Plan of Texas Inc., a physician, and his physicians group. Humana and the plaintiffs reached an out-of-court agreement to cap punitive damages at $1.6 million. Humana is responsible for 35 percent of the $7.4 million damages award. The plaintiffs accused Humana of negligently managing the case of a woman with chronic kidney disease who died in June 2001.... more»
9. Improper Medicare Plan Sales Practices
In May 2007, the Oklahoma Insurance Commissioner ordered Humana Insurance Company to take corrective action against the use of improper sales practices to enroll Medicare beneficiaries. According to a report prepared by the Oklahoma Insurance Department, dozens of Humana agents did not have the proper licenses to sell insurance in the state, and some agents enrolled Medicare beneficiaries in plans they did not understand or want. Humana did not contest the allegations and, in August 2007, agreed to pay a $500,000 fine.... more»
10. Failing to Promptly Report Medicaid Fraud or Abuse
The Florida Agency for Health Care Administration fined Humana Medical Plan $3.4 million for violating a state law requiring the prompt reporting of Medicaid fraud or abuse. The fines included $2.7 million, at a rate of $1,000 each day per violation, for not disclosing the alleged fraud or abuse within 15 days, as required under the state’s HMO regulations. The second fine of $660,400, at a rate of $200 a day, was for violating the terms of its HMO contract with the state. The agency sent Humana two letters accusing the company of failing to disclose information it knew about suspected fraud and abuse by Medicaid providers dating back to September 2009. The state is reportedly investigating possible improper loans or financial assistance made by Humana to Florida providers and improper relationships among providers and company officials.... more»
11. Selling Unauthorized Medicare Prescription Coverage
The Illinois Department of Financial and Professional Regulation ordered Humana Insurance Co. to pay a $500,000 fine to resolve complaints that Humana enrolled Illinois citizens into more expensive and/or duplicative health plans. The IDFPR also determined that, contrary to Illinois law, Humana let unlicensed agents sell policies and failed to notify the state when it fired two of them.... more»
12. Conspiracy to Suppress Payments to Physicians
Humana Inc. settled part of a case in which Kansas City area physicians sued Humana and other health insurance companies for allegedly conspiring to suppress payments to physicians. A class action lawsuit filed in 2005 alleges that the companies violated antitrust laws by fixing prices and engaging in other monopolistic practices, such as refusing to negotiate reasonable reimbursements. Under the settlement, Humana admitted no wrongdoing and agreed to pay $2.8 million in cash, to be distributed among more than 2,200 physicians, and implement initiatives and other commitments with respect to its business practices, the cost of which will have a value of no less than $200,000.... more»
13. Improper Medicare Plan Sales Practices (Wisconsin)
Humana Insurance Company agreed to pay the Wisconsin Office of the Commissioner of Insurance $750,000 to settle allegations that some of the company’s agents who sold Medicare health and prescription drug plans in the state were not properly licensed and that the company violated other insurance laws. State investigators found problems with the company's marketing of Medicare products, its handling of claims and underwriting. The investigation also found Humana failed to pay interest on some adjusted claims and took too long to settle customer grievances.... more»
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