A newly unsealed whistleblower lawsuit alleges insurance giant Humana knew that a Delray Beach doctor for seven years bilked the government through fraudulent Medicare billing for $4.8 million, according to a report this week by the Center for Public Integrity that was published by NPR.
The lawsuit claims that Humana – which operates some of the nation’s largest private Medicare health plans – did little to curb the practice even though it could harm patients.
The Center for Public Integrity is a nonpartisan, nonprofit investigative news organization.
The whistleblower suit was filed by South Florida physician Mario M. Baez and accuses Humana and his former business partner, Dr. Isaac K. Thompson, of Delray Beach, in engaging in a lucrative billing fraud scheme that lasted for years.
In Thompson’s case, Humana paid 80 percent of the money it received to the doctor and retained the rest. Prosecutors charged that fraudulent diagnoses submitted by Thompson between January 2006 and June 2013 generated overpayments of $4.8 million.
Thompson was indicted early last year on health care fraud charges and has indicated he would plead guilty.
The whistleblower suit was filed in October 2012 but remained under a federal court seal until Feb. 26.
Humana, which had no comment, is based out of Louisville and covers more than 3 million elderly patients in its Medicare Advantage plans nationwide. At question in the whistleblower suit is a billing formula called a risk score that pays higher rates for sicker patients.
To read the whole story by the Center for Public Integrity click here.