Humana, Provider Settle Medicare Managed Care Fraud Suit for $3M

Health insurer Humana settled a whistleblower lawsuit over alleged Medicare managed care overpayments, though the DOJ could still be investigating the company’s overall Medicare Advantage business.

Humana, along with co-defendant medical practice Plaza Medical Centers and its owner Michael Cavanaugh, entered into a $3 million settlement agreement resolving False Claims Act allegations brought by Plaza’s former owner, physician Olivia Graves. Graves alleged that Plaza Medical was coding Medicare Advantage patients as having more illnesses than they actually suffered from, and accused Humana of either knowing of the improper upcoding or deliberately ignoring it while submitting the false claims to Medicare ...