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Federal Contractor Misconduct Database (FCMD)

The federal government routinely awards contracts to companies with histories of misconduct, including contract fraud and other violations. POGO believes that providing this website will help to improve contracting decisions and increase public knowledge of how the government spends billions of taxpayer dollars each year. Read more…

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.

Misconduct Type
Antitrust
Enforcement Agency
Non-Governmental
Contracting Party
None
Court Type
Civil
Disposition
Settlement
Date of Settlement
10/23/2003
Contractors Involved Penalty
Total
Humana $106,000,000
Further Information Released
Settlement Agreement 4/6/2007
SEC 10-K (p. 24 of 145) 10/13/2006

Federal Contractor Misconduct Database