Dive Brief:
- A regulatory filing by Humana this week indicates that the US Justice Department has asked the insurer for information regarding its Medicare Advantage risk-adjustment practices, in an inquiry that is separate but related to a whistle-blower case filed in 2010.
- Humana's disclosure reveals that the company recently received a request from federal officials seeking details about how it submits and manages its risk-adjustment data.
- The 2010 whistleblower case alleged that Humana and one of its physician clinics purposely provided claims to Medicare with falsified patient risk scores.
Dive Insight:
Modern Healthcare notes that the issue stems from how the CMS pays Medicare Advantage insurers. Part of the determination comes from risk scores that reflect how sick the insurer's subscribers are, and higher risk scores mean higher payments.
Humana has not commented on the situation to the media, but wrote in its filing, "We continue to operate with and voluntarily respond to the information requests from the Department of Justice and the US attorney's office."
Humana is the second-largest Medicare Advantage insurer in the US, serving nearly 3.2 million members, according to Modern Healthcare.