Managed Care Report

• Humana (Louisville, KY) agreed to reimburse the government $14.5 million as part of a settlement to cover the Justice Department’s (Washington) investigation of the company. Lawyers for the department alleged that Humana had illegally double-billed the government, seeking payments from Medicare and Medicaid for a number of patients over an eight-year period. From 1990 to 1998, government lawyers said Humana duped the government into paying millions of claims under the two separate programs. Also as part of the settlement and in order to continue to receive government-supported customers, Humana entered into a five-year corporate-integrity agreement with federal regulators, pledging not to violate federal laws on reimbursement and related matters.

• Americaid (Chicago) has named Prentiss Taylor vice president of medical affairs for the health plan. In his new position, Taylor will be responsible for Americaid’s medical management, health promotion, and disease, utilization, and quality management.

• Aetna U.S. Healthcare (Blue Bell, PA) has received approval from the State of Texas Department of Insurance to begin offering its HMO products, including HMO, QPOS, and USAccess, to residents in Austin. Members of Aetna U.S.’s new HMO will have access to the company’s local network of more than 1,150 physicians in Austin, Aetna U.S. said. The company has developed a number of preventitive and wellness programs for its managed care members, including Healthy Outlook disease management programs, outreach programs to encourage childhood immunizations, and the Aetna U.S. Healthcare Check programs. In Austin, the company already provides health coverage to more than 53,000 members through its preferred provider organization, point of service, and traditional indemnity plans, Aetna U.S. said.