- CMS hit Humana with a $3.1 million fine for violations related to its Medicare operations.
- Levied last week, the fine stems from a 2015 audit of Medicare Advantage and prescription drug plans.
- Humana was on a list of 129 organizations receiving civil penalties and enrollment and marketing suspensions that CMS released.
When CMS auditors looked at Humana’s Part C and Part D operations, they found systemic failings, which resulted in benefits being delayed or denied and enrollees having to pay for care out of pocket, Healthcare Payer News reported.
Humana’s penalty was the largest of the organizations called out for Medicare violations. Others slapped with fines of $1 million or more include Envision Pharmaceutical Services ($2.59 million), Medical Card System ($1.29 million) and Aetna ($1 million).
The violations related to Part D formulary benefit administration, coverage determinations, complaints and appeals in both Parts C and D, and invalid data submissions.
Humana has taken steps to correct the problems and will conduct an independent audit in the next few months and report the findings to CMS, a spokesman told Louisville Business First.
The company’s CEO, Bruce Broussard, is poised to get a $40.2 million “golden parachute” payment if the company’s sale to Aetna closes, Modern Healthcare reported. The deal, announced last summer, is under review by the U.S. Department of Justice’s antitrust team.