Humana Medicare Fraud Report 2012

Humana

The 3 principles of Humana Medicare fraud

Humana Fraud Report 2012

Below is the Humana Fraud Report for 2012. The report is an updated history of Humana’s misconduct over the past decade.

Humana Fraud

Humana Financials
40% denial rate (Healthcare.Gov, AMA)
CEO compensation: $7.3 million (up 15% according to CNBC)
$426 million profit (3Q 2012 results, CNBC)
$9.65 billion premium revenue (3Q 2012, up 3.8% from 2Q results, CNBC)
24% increase premium prices for 2013 (CMS, AMA, CNBC)
80% medical loss ratio
Stock down 22.86% Year To Date due to Medicare fraud and health care reform (CNBC)

People Responsible for Denials

Michael McCallister – CEO

Kurt Hilzinger – Partner at Court Square Capital Partners

Frank D’ Amelio – CFO of Phizer

Roy Dunbar – CEO of Network Solutions

David Jones – Chairman of Chrysalis Ventures (venture capital firm)

William McDonald – EVP of Capitol One

William Mitchell – Managing Partner of Sequel Capital

David Nash, MD

James O’Brien – CEO of Ashland Inc (chemical)

Marissa Peteson – EVP Sun Microsystems

 

History of Medicare Fraud

Fined $3.4 million    -  August 2011

Fined $133 million  – October 2005

Fined $8 million       – June   2001

Fined $14.5 million  -  June 2000

Fined $8 million        – November 1999

————————————————————–

History of Non-Medicare Fraud:

Fined $45,000,000  – May 2012

Fined $314,000     – June 2011

Fined $299,000     -  June 2011

Fined $100,000     -  January 2011

Fined $55,800       – October 2010

Fined $2.8 million  – March 2008

Fined $500,000      – January 2008

Fined $500,000     – August 2007

Fined $4,190,000 million – July 2005

Fined $1,013,259 million – July 2005

Fined $3.5 million   – May 2005

Fined $10.2 million – November 2003

Fined $106 million – October 2003

Fined $78.5 million – January 2000

Fined $10 million    – July 1999

——————————————————————–

Medicare Fraud Fines:               $166,900,000 million

Non-Medicare Fraud Fines:      $264,740,859 million

Total  Fraud Fines:                      $431,640,859 million

According to the American Medical Association, Humana has been fined $4,175,113 by state governments since 2000 for failing to pay physicians in a timely manner.

Humana ordered to pay family $7,400,000 in a wrongful death lawsuit for wrongfully denying care on purpose in order to save corporate profits in 2005.

Pocketed $19.3 million from employees in Kentucky (its Headquarters) and Ohio  (U.S. Justice Department)

CPT Codes Most Downcoded by Insurance Company:
Code:                                                    Medicare Rate:                                         Usual Downcoding Amount
99204 (level 4 new office visit)       $170.47                                                      $43.13
99203 (leve 3 new office visit)         $110.92                                                       $59.55
99202 (level 2 new office visit)        $76.88                                                        $34.04
99201  (level 1 new office visit)        $44.77                                                         $32.11
99214  (level 4 established patient)  $111.39                                                      $38.21
99213  (level 3 established patient)   $74.46                                                      $36.93
99212  (level 2 established patient)   $44.77                                                      $29.69
99215 (level 5 established patient)   $149.60                                                    $108.47
99233 (level 3 hospital progress note)   $108.67                                                $34.01
99232 (level 2 hospital progress note)   $75.78                                                  $32.89
99231 (level 1 hospital follow up)            $42.12                                                  $33.66

According to the American Medical Association and several practicing physicians, Humana most often downcodes 99213, 99214, and 99215. According to one particular physician, Humana has downcoded  these three codes by as much as $161.84.

In 2001, a physician exposes a massive scam Humana is running in order to get more profit for their shareholders and executives.

 

Humana Fraud Report 2012

Listed above is an updated history of Humana’s misconduct. Stay tuned to see how Humana will do in 2013.

photo credit: http://www.tuition.io/blog/wp-content/uploads/2012/12/Studen-Loan-Fraud-Triangle.jpg

Matthew D.  Taber, M.S. is Chief Operating Officer of Medical Access USA (www.medicalaccessusa.com),  a company which offers full access to medical care to patients and  100  percent reimbursement to primary care physicians through direct primary care models.  Reach him by e-mail at mdtaber at me dot com or by phone at 615-669-8347 to receive a free webinar presentation and evaluation of your medical practice.  

 

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