Tag: Humana

INDIANAPOLIS - Roche Diagnostics and Humana have agreed to settle a whistleblower lawsuit for $12.5 million, after the government declined to intervene in the case.  Roche was charged with violating the Anti-Kickback Statute and False Claims Act, causing false claims to be submitted to the Medicare Advantage program and defrauding taxpayers, in a lawsuit filed in 2014 in the U.S. District Court for the Northern District of Illinois by a former employee of the company.  Humana...

AAHomecare is drafting a response to Humana's decision to make changes in its authorization process for non-invasive ventilators, including providing only a 90-day initial authorization and requiring compliance data to extend authorization. The association has a number of concerns with the change, including how it will impact patients, how it might result in re-hospitalizations, how it's inconsistent with Medicare requirements, and how it's a more restrictive authorization process during a public...

AMSTERDAM - Royal Philips is collaborating with Humana to improve care and health outcomes for select high-risk Medicare Advantage members. Humana has implemented two programs that leverage Philips' medical alert services and remote member monitoring solutions. “Our goal is to continue to find ways to help our Medicare Advantage members stay longer and safer in their homes,” said Susan Diamond, president of Humana's Home Business Segment. “We believe our work with Philips will help...

SAVANNAH, Ga. - More than a year after Humana Military took over the Tricare East contract, there are still billing issues, providers report.Provider David McLeod, for example, has been told he must submit a certificate of medical necessity every time he submits a claim for a CPAP device because the claims processor doesn't have the ability to attach a CMN already on file.“Essentially they are saying that, for us to get paid, we have to go through the whole process of submitting paperwork for...

New Braunfels, Texas - Humana opened its first community pharmacy in Texas at the Partners in Primary Care medical practice. The new pharmacy, an extension of Humana's mail-order prescription drug service, will provide clinical support and full pharmaceutical services to Humana customers. The insurance company intends to open a second pharmacy in Texas and four more in Florida over the next few months.

WASHINGTON - The National Community Pharmacists Association (NCPA) supports today's hearing examining the consolidation in the healthcare marketplace, conducted by the House of Representatives Subcommittee on Regulatory Reform, Commercial and Antitrust Law. Of particular concern: the proposed Anthem-Cigna and Aetna-Humana mergers. “Policymakers cannot allow the 'merger mania' gripping the nation to proceed in a way that harms patients and the community pharmacists who serve them,” said...

YARMOUTH, Maine - HME providers and billing experts are reporting a recent spike in audits by insurance giant Humana and health plan manager CareCentrix.“I open the mail here for one reason,” said Robert Slama, CEO of Lakeland, Fla.-based Medi-Healthcare, who's been audited by both companies. “I want to see the amount of recoupments going on.”Why the sudden scrutiny?“They got wind that they could get a lot of money back,” said billing consultant Sylvia Toscano,...

LAKE FOREST, Calif. - Apria Healthcare may have a lot to lose from Humana's decision to use pricing from Round 2 of competitive bidding for its Medicare Advantage plans starting July 1.Back in 2011, the insurance giant sent shock waves through the industry when it named Apria its “provider of choice” in multiple states and terminated relationships with “several providers.”When contacted by HME News, Lisa Getson, executive vice president of government relations and corporate...

LOUISVILLE, Ky. - When it comes to the steep cuts Medicare plans to implement as part of Round 2 of competitive bidding, industry stakeholders have been waiting for the other shoe to drop.In the wake of the announcement of the cuts—on average, 45% below the current fee schedule—there have been reports of private payers and Medicaid programs looking to slash pricing. But now, it looks like it's happening on a much bigger scale.Health insurance giant Humana on May 30 notified providers...

CASSELBERRY, Fla. - HME providers in Texas say they've been losing Humana patients to Apria Healthcare “left and right,” and stakeholders worry the problem could spread.“We fear and anticipate that we are going to see it as a national trend,” said Liz Moran, executive director of the Medical Equipment Suppliers Association (MESA), which counts Texas as one of its five member states. Humana and Apria entered into a multi-state preferred provider contract in 2011. Since...