Amazing. Absofreakinlutely amazing. I mean, with Florida's governor having a history of Medicaid and Medicare fraud, it's amazing that Florida fined Humana $3.3 million for not reporting Medicaid fraud to the state as required by Florida law.
huh?
I wonder if that $3.3 million fine will prevail? I would never have expected a Rick Scott administration to level a fine on anyone for Medicaid fraud. It kind of begs the question of if he knew anything about it. Then, again, $3.3 million is far less than the $1.7 billion Rick Scott presided over when he headed up HCA. None the less, Humana Florida got notice of the bad news last week.
It's just that over the years working in health care, I've been around a little bit of litigation and when it comes to a Medicaid or Medicare fraud settlement; the $3.3 million is the government's opening bid. Chances are the fine will fall considerably as Humana's lawyers "work the problem".
The Sun Sentinel didn't give many details. The crux of it is that Mike Blackburn, chief Medicaid inspector general at Florida's Agency for Health Care Administration sent to letters to Humana's Miramar Florida's office informing them of the pending fines.
The company did not disclose what it knew about suspected fraud and abuse by Medicaid providers — such as doctors and hospitals — or recipients back as far as Sept. 1, 2009, health regulators said in two letters sent last week to Humana's Miramar office.
The letters said the state fined the company $2.7 million — at $1,000 a day per violation — for not disclosing fraud or abuse as the law requires Medicaid HMOs to do within 15 days of discovering it.
A second fine of $660,000 — at $200 a day — says the company's failure to disclose the fraud violates the terms of its contract as a Medicaid HMO.
This fine has to do with Medicaid, not Humana's primary business of being a Medicare HMO. Humana is considered the second-largest Medicare insurer, with 4.3 million members throughout the U.S. They will have plenty of money to fight these fines.
The Florida operation has a respectable size of 568,000 members between the Humana brand and its CarePlus subsidiary. They are largest and most profitable HMO and Humana's profits (2010 Annual Report pdf) from their Florida operations is estimated to be $330 million in 2010, so a fine that amounts to 1% of last years profits from one of the company's regions isn't likely to get Humana to change their ways. It will make them more circumspect in how they go about "detecting" fraud and abuse.
So, as amazing as this action is that Florida levied a fine on Humana; I'm waiting for the funds to clear the bank before I celebrate.