Humana fined $3.4 M for not reporting fraud

The Agency for Health Care Administration (AHCA) in Florida has fined Louisville, KY-based Humana $3.4 million for failing to report suspected or confirmed Medicaid fraud to the state on a timely basis.

Florida state law requires that healthcare providers report fraud within 15 days. The agency informed the company of two penalties: one for $660,400, a rate of $200 per day for violating its contract with the state; and another for $2,732,000, a rate of $1,000 per day as prescribed by state law.

AHCA reports that Humana had discovered the instances of suspected fraud far back as September 2009 and as recently as January 2010 before reporting them to the state. The longest violation was 536 days past the 15-day requirement.

The fines related to 16 suspected fraud cases, 12 of which were investigated but then closed with no findings of fraud, and the other four remained under investigation by Humana, AHCA reports. Of the 16 suspected cases, one involved "provider shopping," five were suspected upcoding, three concerned "questionable charges," one involved "services not rendered," and the remaining six were investigations of "excessive services."