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Lawsuit says Humana encourages treatment denials to gain profit

Humana Inc., one of the nation's largest health insurers, faces another lawsuit claiming it has offered doctors, hospitals, and other medical providers discounts and incentives to deny some medical treatment in order to reap a bigger profit.

The New Orleans-based consumer law firm Herman, Middleton, Casey & Kitchens filed the lawsuit April 20 in the U.S. District Court for the Southern District of Florida in Miami. Lawyers, who brought the lawsuit on behalf of Humana customers nationwide, are seeking class action certification.

The lawsuit also charges that Humana failed to pass the discounts it obtained for itself on to its customers.

Dick Brown, a spokesperson for Humana, which has nearly 6 million customers in the United States, says his company has been hit with about a half dozen similar lawsuits since last fall. "These are all plaintiffs' attorneys who are looking to enrich their pocketbooks," he says. "On the face of it, this action is no different than the others that have been filed against Humana. . . . We believe we have done no wrong, and we will vigorously defend ourselves against these charges."

The complaint alleges that Humana, Humana Insurance Co. Inc., and Humana Medical Plans Inc. rewarded health care providers who chose cheaper methods of treatment and diagnosis and who failed to disclose to patients other more costly, and often more appropriate, methods of treatment. The lawsuit also charges that Humana failed to pass the discounts it obtained for itself on to its customers.

The complaint asserts that Humana included "gag orders" in its agreements with medical providers that prohibited doctors and other medical care providers from telling patients about alternative medical treatment. According to the lawsuit, Humana adopted arbitrary claims adjusting and guidelines that denied patients medical care.

Lawyers contend Humana is liable under the federal Racketeer-Influenced and Corrupt Organizations Act for repeated and fraudulent conduct involving material misrepresentations and misleading omissions in disclosures to its customers about how coverage decisions are made.

The lawsuit seeks to force Humana to turn over an unspecified amount of profit. It also seeks damages and legal costs.

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