Whistle-blower lawsuit sparks federal probe of Humana

Louisville, Ky.-based Humana has disclosed in a regulatory filing that it is the subject of a federal probe, which is related to a qui tam, or whistle-blower, lawsuit filed against the health insurer.

According to the filing, the U.S. Department of Justice "recently" issued an information request to Humana concerning the health insurer's Medicare Part C risk adjustment practices.

The information request is "separate from but related to" a whistle-blower lawsuit filed under the False Claims Act by Olivia Graves, MD, according to the filing. The lawsuit, which was originally filed in 2000, alleges a Humana-owned clinic engaged in the practice of "diagnosing an unusually high number of patients with conditions such as diabetes with complications, even if the conditions weren't supported by the patients' medical records, in order to boost Medicare reimbursement rates," according to a Law360 report.

The DOJ request relates to Humana's "oversight and submission of risk adjustment data generated by providers" in its Medicare Advantage Network and risk adjustment data generated by Humana and its providers, according to the regulatory filing.

"We continue to cooperate with and voluntarily respond to the information requests from the Department of Justice and the U.S. Attorney's Office," Humana said in its regulatory filing.

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