Humana Inc. (HUM), the second-biggest provider of private Medicare coverage, said the U.S. Justice Department is investigating its coding of medical claims from South Florida doctors and loans made to physician practices.
The U.S. Attorney’s Office in Miami requested documents and other information from Humana and its affiliates on Jan. 6, the Louisville, Kentucky-based health insurer said in a regulatory filing yesterday. Humana didn’t say how it responded, and didn’t respond immediately to a telephone call seeking comment.
Humana last year disclosed its own investigation into enrollment practices and loans to providers in its Medicare and Medicaid networks in Florida. The company also faces a whistle- blower lawsuit alleging its practices in that state violated a federal anti-kickback statue, according to the filing.
The company said yesterday its internal probe is continuing and involves “relationships” between some of its Florida employees and Medicare and Medicaid providers, the financial support of nonprofit or provider centers that enroll Medicare patients and “financial support” made to doctor practices.
Humana earned 65 percent of its $36.8 billion in revenue last year from providing drug and medical benefits to people on Medicare, the U.S.-backed insurance plan for the elderly and disabled. It got 2.6 percent of revenue from Medicaid, the joint state-federal program for the poor.
Alicia Valle, spokeswoman for the U.S. Attorney’s office in Miami, didn’t return a call seeking comment on the investigation.
The insurer rose 4.5 percent to $84.33 at the close of New York trading. The shares fell 8.1 percent yesterday, the most in three years, after the company said first-quarter profit had dropped 21 percent, missing analyst estimates.
UnitedHealth Group Inc. (UNH) of Minnetonka, Minnesota, is the biggest private Medicare insurer in the U.S.
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