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Humana pays Florida $8 million to settle charges of double-dipping

Humana has agreed to pay Florida $8 million to settle allegations that it billed both Medicare and Medicaid for the same services. The settlement is believed to be the first of its kind in the nation, according to James F. McAuley, the Florida assistant attorney general who helped handle the case.

"I can tell you the problem will not be rampant in the future."

According to McAuley, the state's attorney general's office is currently investigating several Florida HMOs for double-billing. When asked if the practice is rampant in Florida's HMO industry, McAuley replied: "I can tell you the problem will not be rampant in the future."

On June 28, 2001, Florida Attorney General Bob Butterworth announced that Humana Medical Plan Inc. will settle the double-billing charges without admitting any wrongdoing. Butterworth says the insurer has also agreed to revise its billing practices.

According to Butterworth, Humana has agreed to reimburse Medicaid for all funds that were paid by both government agencies.

The charges stem from a nearly two-year investigation that showed Humana received duplicate payments from Medicare and Medicaid for the same patients on a monthly basis from July 1, 1992, through Dec. 31, 2000. According to Florida statutes, patients who are eligible for both Medicare and Medicaid coverage are required to be covered primarily through Medicare.

Humana spokesperson Pam Gadinsky says the insurer never intended any wrongdoing and inherited the billing problems when Humana purchased Physicians Corp. of America in 1997. "We weren't even aware of problems until 1999," Gadinsky says.

Florida's top HMOs continue to come under heavy attack by both patients and doctors who have filed racketeering charges in United States District Court in Miami against HMO industry leaders, including Humana.

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