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Posts Tagged ‘Cigna’

Accountable Care Organizations Caught Defrauding Medicare by $2.20 BIllion!

June 25, 2012 Leave a comment

Accountable Care Organizations (ACOs) have been established and are operational. Blue Cross Blue Shield, Cigna, Humana, and United Healthcare specifically already have theirs set up. Unfortunately, these same companies have been caught by the U.S. federal government defrauding Medicare on purpose by a whopping $2,208,408,879 billion.
—————————————————————————————————————————————– Blue Cross Blue Shield
Actual Fraud Amount:  $522,180,879  (Source 1,2,3,4,17
Settlements:                    $302,100,000  (Source: 5,6,7,8, 9, 17, 18)

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Cigna
Actual Fraud Amount:  $74,500,000
Settlements:                          $58,000,000  (Source 16)
——————————————————————————————————————————

Humana
Actual Fraud Amount:   $311,800,000
Settlements:                     $155,500,000  (Source: 10,11,12,13)
—————————————————————————————————————————————–

United Healthcare
Actual Fraud Amount:    $1,300,000,000  (Source 14)
Settlements:                       $97,500,000       (Source 15, 16)
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Sources:
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Health Insurance Companies Fined $940 Million for Failing to Reimburse Physicians

June 24, 2012 Leave a comment
Health insurance companies  routinely do not reimburse physicians on purpose in order to protect company profits. This problem has skyrocketed over the past decade alone. During this particular time period, One hundred nine companies were fined $940,445,363 for failing to pay physicians in a timely manner.  States gave 104 companies 455 fines totaling $156,951,581.   Forty four are non-profit and they were fined 170 times totaling $62,030,981.  Sixty five are for-profit and they were fined 285 times totaling $94,920,600.  Ten for-profit companies had federal ERISA settlements against them which totaled $784,855,000. Blue Cross Blue Shield had the most fines of the non-profit sector which totaled $54,645,878. UnitedHealthcare was fined the most of the for-profit sector which totaled $417,514,675.
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Not-for-Profit
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Affinity
# of State Fines:   5
Total State Fines:  $30,900  (Source 1
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Alameda Alliance
# of State Fines:    1
Total State Fines:  $333,229    (Source 1
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Blue Cross Blue Shield
# of Fines:   43
Total State Fines:  $54,645,878  (Source 1
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Capital District Health Plan
# of State Fines:    6
Total State Fines: $55,700  (Source 1
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Centercare
# of State Fines:  3
Total State Fines: $8,200  (Source 1
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Community Choice
# of State Fines:  2
Total State Fines:  $10,300   (Source 1
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Community First Health Plans
# of State Fines:    1
Total State Fines:  $200,000    (Source 1
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Community Health Plans of NY, Washington
# of State Fines:    4
Total State Fines:  $1,005,200  (Source 1
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Community Premier Plus
# of State Fines:    1
Total State Fines:  $1,200    (Source 1
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Fidelis
# of State Fines:    5
Total State Fines:  $10,100  (Source 1
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FreeState
# of State Fines:    1
Total State Fines:  $7,500  (Source 1
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HM Health Insurance
# of State Fines:   1
Total State Fines:  $500 (Source 1
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Group Health Cooperative
# of State Fines:    15
Total State Fines:  $57,050 (Source 1
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Health Services Med Corp
# of State Fines:    1
Total State Fines:  $7,300 (Source 1
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Healthcare Underwriters Mutual
# of State Fines:    1
Total State Fines:  $9,750  (Source 1
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HealthNow (Medicare Advantage)
# of State Fines:    12
Total State Fines:  $1,170,300 (Source 1
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Health Plus
# of State Fines:    3
Total State Fines:  $75,200  (Source 1
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Healthsource plan of NY/NJ
# of State Fines:    2
Total State Fines:  2,200 (Source 1
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Heritage Provider Network
# of State Fines:    2
Total State Fines:  $294,000  (Source 1
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HM Health Insurance
# of State Fines:   1
Total State Fines:  $500 (Source 1
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Hometown Health Plan
# of State Fines:    1
Total State Fines:   $25,000 (Source 1
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Indemnity Insurance Company
# of State Fines:    1
Total State Fines:  $1,800 (Source 1
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Independent Health Association
# of State Fines:   5
Total State Fines:  $49,775 (Source 1
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Inland Empire
# of State Fines:    1
Total State Fines:  $2,500  (Source 1
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Inter Valley
# of State Fines:    1
Total State Fines: $7,500   (Source 1
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JMH Health Plan
# of State Fines:    1
Total State Fines:  $25,000 (Source 1
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Kaiser Foundation Health Plans
# of State Fines:    13
Total State Fines:  $792,800 (Source 1
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Lifewise Health Plan
# of State Fines:    1
Total State Fines:  $1,250 (Source 1
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Managed Health Network
# of State Fines:    2
Total State Fines:  90,000  (Source 1
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Mayo Health Plan
# of State Fines:    1
Total State Fines: $25,000  (Source 1
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Med Mutual of Ohio
# of State Fines:    1
Total State Fines:  $100,000 (Source 1
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Mercy Health Plans
# of State Fines:    1
Total State Fines:  $100,600 (Source 1
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Molina
# of State Fines:    1
Total State Fines:  $5,000 (Source 1
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MVP Health Plan
# of State Fines:    3
Total State Fines: $35,000  (Source 1
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Promina Health Plan
# of State Fines:    1
Total State Fines: $81,635  (Source 1
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Providence Health Plan
# of State Fines:    2
Total State Fines:  $3,750 (Source 1
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Sharp Health Plan
# of State Fines:    1
Total State Fines:  $20,000  (Source 1
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Sloans Lake
# of State Fines:    1
Total State Fines:  $156,750 (Source 1
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St. Barnabus (Partners in Health)
# of State Fines:    1
Total State Fines:   $1,300 (Source 1
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St. Joseph’s Care Management
# of State Fines:    1
Total State Fines:  $33,538 (Source 1
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SummaCare
# of State Fines:    1
Total State Fines:   $125,000 (Source 1
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Unicare Life
# of State Fines:    6
Total State Fines:  $1,533,426 (Source 1
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Univera / Health Plan Inc (NY)     NP
# of State Fines:    2
Total State Fines:  $24,550 (Source 1
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Vytra
# of State Fines:   9
Total State Fines:  $483,800 (Source 1
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For-Profit
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Aetna  (Public Traded)
# of  State Fines:     31
Total State Fines:  $8,262,982  (Source 1
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American Heritage Life (AllState, Publicly Traded)
# of State Fines:  2
Total State Fines: Fined $264,765  (Source 1
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American Medical Life
# of State Fines:     1
Total State Fines $1,000       (Source 1
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Amil International Insurance Company
# of State Fines:   2
Total State Fines  $196,543  (Source 1
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Alta Health and Life
# of State Fines    1
Total State Fines: $250  (Source 1
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Avemco Insurance
# of State Fines:   2
Total State Fines: $269, 729  (Source 1
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Beacon Health Plan
# of State Fines: 1
Total State Fines: $50,000    (Source 1
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Capitol American Life
ERISA Settlement:  $6,826,000 (Source 6
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Careplus
# of State Fines: 4
Total State Fines:  $28,345  (Source 1
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Central Reserve Life
# of State Fines:  2
Total State Fines:   $811,513 (Source 1
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CHA HMO
# of State Fines:  1
Total State Fines:  $43,750   (Source 1
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Cigna (Publicly Traded)
# of State Fines:    26
Total State Fines:  $4,954,534 (Source 1
ERISA Settlement:  $954,000  (Source 6
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Combined Insurance Company of America of Illinois
# of State Fines:  1
Total State Fines:  $30,000   (Source 1
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Conseco Medical Insurance Company
# of State Fines:    3
Total State Fines:    $1,820,610  (Source 1
ERISA Settlement: $9,975,000   (Source 6
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Continental Assurance
# of State Fines:    3
Total State Fines:   $161,212   (Source 1
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Coventry
# of State Fines:  1
Total State Fines:  $10,000  (Source 1
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CVS
ERISA Settlement: $3,000,000  (Source 6
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Dental Benefit Providers Maryland
# of State Fines:    2
Total State Fines:   $80,000  (Source 1
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Excellus
# of State Fines:    8
Total State Fines:   $36,400  (Source 1
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Florida 1st Health Plan
# of State Fines:    1
Total State Fines:  $25,000  (Source 1
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Fortis Insurance
# of State Fines:   3
Total State Fines:  $1,410,055  (Source 1
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Foundation Health
# of State Fines:    1
Total State Fines:  $50,000 (Source 1
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FreeState
# of State Fines:    1
Total State Fines:   $75,000 (Source 1
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Great West Healthcare
# of State Fines:    4
Total State Fines:  $2,323,669  (Source 1
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Guardian Life
# of State Fines:    6
Total State Fines:  $1,440,305 (Source 1
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Hartford Casualty Insurance Company
# of State Fines:    1
Total State Fines:  $20,000  (Source 1
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Health Care Plan of NY
# of State Fines:    1
Total State Fines:   $20,500 (Source 1
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Health Insurance Plan of NY
# of State Fines:    10
Total State Fines:  $351,350 (Source 1
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Health Net
# of State Fines:    9
Total State Fines:  $521,700 (Source 1
ERISA Settlement: $215,000,000  (Source 6)
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Health Options
# of State Fines:    1
Total State Fines:  $50,000  (Source 1
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Healthplan Southeast
# of State Fines:    1
Total State Fines: $50,000   (Source 1
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HMO Colorado
# of State Fines:  1
Total State Fines:  $252,500  (Source 1
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Human Affairs
# of State Fines:    1
Total State Fines:  $5,500 (Source 1
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Humana (Publicly Traded)
# of State Fines:    9
Total State Fines:  $2,879,113 (Source 1
ERISA Settlement:  $58,000,000  (Source 8
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LifeGuard
# of State Fines:    1
Total State Fines:  $40,000 (Source 1
——————————————————————————————————————————————-
Magellan
# of State Fines:    2
Total State Fines:  $450,000 (Source 1
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Meco Health Solutions
ERISA Settlement: $42.5 million
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Med Insurance Company of Ohio
# of State Fines:    1
Total State Fines:  $60,000 (Source 1
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Mega Life and Health Insurance Company
# of State Fines:    3
Total State Fines:  $875,000  (Source 1
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MetLife Insurance Company
# of State Fines:   5
Total State Fines: $1,343,428  (Source 1
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MDNY
# of State Fines:    9
Total State Fines:  $185,650  (Source 1
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Merit  Behavioral
# of State Fines:    1
Total State Fines:  $7,500  (Source 1
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Mid-South Insurance Company
# of State Fines:  1
Total State Fines:  $51,850 (Source 1
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Mid-West National Life
# of State Fines:    2
Total State Fines:  $140,500  (Source 1
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New England Life
# of State Fines:    1
Total State Fines:  $41,500 (Source 1
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New York Life Insurance
ERISA Settlement: $14,000,000  (Source 6)
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NYL Care
# of State Fines:   5
Total State Fines:  $1,092,050 (Source 1
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Oriska Insurance
# of State Fines:    1
Total State Fines:  $3,900 (Source 1
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Oxford Health Plans
# of State Fines:    13
Total State Fines:  $5,046,674 (Source 1
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Pacific Life and Annuity Company
# of State Fines:    3
Total State Fines: $3,530,579  (Source 1
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Physicians Healthcare Plans
# of State Fines:    2
Total State Fines:  $78,300 (Source 1
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Principal Life Insurance Company
# of State Fines:    2
Total State Fines:  $704,856 (Source 1
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Protective Life Insurance Company
# of State Fines:    2
Total State Fines:  $152,780 (Source 1
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Prudential
# of State Fines:    6
Total State Fines:  $216,000  (Source 1
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Qualmed Washington
# of State Fines:    1
Total State Fines:  $250,000 (Source 1
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Renaissance Health and Life
# of State Fines:   1
Total State Fines:  $1,750 (Source 1
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Rite Aid
ERISA Settlement: $67,600,000 (Source 6)
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Safeguard Health Plans
# of State Fines:    3
Total State Fines:  $239,339 (Source 1
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Sierra Health / Texas Health Choice Companies
# of State Fines:    3
Total State Fines:  $1,437,450 (Source 1
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Systemas Medicos
# of State Fines:    1
Total State Fines:  $7,500  (Source 1
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Trustmark Insurance Company
# of State Fines:    2
Total State Fines: $595,676  (Source 1
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United American Insurance Company of McKinney
# of State Fines:   1
Total State Fines:   $190,000 (Source 1
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United Healthcare
# of State Fines:    59
Total State Fines:  $50,514,675  (Source 1, 2, 3,4, 5
ERISA Settlement: $17,000,000 (Source 6
ERISA Settlement: $350,000,000 (Source 7
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Vista Health Plan
# of State Fines:    1
Total State Fines:  $50,000 (Source 1
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Well Care
# of State Fines:    6
Total State Fines:  $147,100 (Source 1
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 Sources:
2. http://americustimesrecorder.com/local/local_story_%20003234020.html
3. www.texmed.org/Template.aspx?id=6325
4. http://www.newsobserver%20.com/news/stor%20y/1152663.html
5. http://azstarnet.com/all-headlines/119565/
6. http://www.erisasettlements.com/press/ERISA-Chart.pdf

7. http://www.healthdatamanagement.com/news/ama-unitedhealth-insurance-lawsuit-ingenix-database-43997-1.html

8. http://www.bizjournals.com/milwaukee/stories/2005/10/17/daily14.html?from_rss=

Health Insurance Companies Should Pay $4.3 Billion for Defrauding Medicare/Medicaid

June 19, 2012 1 comment
The total amount that health insurance companies should pay for defrauding Medicare and Medicaid is $4,319,180,879 billion. The insurers have settled with the government for only $1,502,300,000 billion (34% of total fraud amount). The government settled at an average rate of 45% of the total amount defrauded. Total amount that was pocketed by the insurers (unrecovered) is $2,816,880,879 billion.  This is all found via public records. The amount of money in some recent cases that has been unreported (sealed by Judge) is probably a high amount as well and probably would greatly inflate the total amount I was able to find.
Amerigroup
—————-
Actual amount of Fraud:      $524,700,000
Settlements:                           $225,000,000    (Source 1)
% Settled for                           42%
—————————————————————-
 Blue Cross Blue Shield
Actual Amount of Fraud        $522,180,879     (Source 2, 3, 4, 5, 23)
Settlements:                            $302,100,000        (Source 6,7, 8, 9, 10, 23, 26)
% Settled for                            57%
 ———————————————————————————–
CareMark
Actual Amount of Fraud:        $110,000,000 million
Settlements:                           $54,200,000 million     (Source 26, 27,28)
 % Settled for                         49%
 —————————————————————————–
Cigna
Actual Amount of Fraud       $74,500,000
Settlements:                           $58,000,000   (Source 19)
% Settled for                           77%
 ————————————————————————–
 Humana
Actual Amount of Fraud       $311,800,000
Settlements:                           $155,500,000    (Source 13, 14, 15, 16)
% Settled for                           50%
——————————————————————————–
 Medco
Actual Amount of Fraud:       $430,000,000 million
Settlements:                            $155,000,000 million  (Source 24, 25)
% Settled for                            36%
 —————————————————————————-
 UnitedHealthcare /Pacificare
Actual Amount of Fraud       $1,300,000,000 billion (Source 17)
Settlements:                                  $97,500,000 million (Source 18, 19)
% Settled for                          7%
 —————————————————————————-
WellCare
Actual Amount of Fraud:         $1,046,000,000 billion (Source 20)
Settlements:                              $455,000,000 million  (Source 21, 22)
% Settled for                              43%
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Total Fraud                                                               $ 4,319,180,879
Settlements                                                               $1,502,300,000
Average % of total fraud amount Settled for:  45%
Insurers Pocketed:                                                  $2,816,880,879
———————————————————————————————————————–
Sources:

22. http://www.ama-assn.org/amednews/2010/07/12/bisa0712.htm

Conservative Justice Scalia: Reform without Mandate would Bankrupt Health Insurance Companies!

June 7, 2012 Leave a comment

U.S. Supreme Court Justice Antonin Scalia has come out recently saying that if the individual mandate is ruled unconstitutional, it would bankrupt health insurance companies. According to Court transcripts of the hearing on severability of the Affordable Care Act, Justice Scalia argued: “There is going to be a deficit that used to be made up by the mandatory coverage provision. All that money, has to come from somewhere…So you’re just put to the choice of, I guess bankrupting insurance companies.” (Source 1).  Bankrupting the for-profit companies of Humana, Aetna, WellPoint, Cigna, and United Healthcare might not be a bad thing as they are again under indictment for defrauding the federal government on purpose in order to get profit for their shareholders. These companies have been caught in the past doing the same thing and they have managed to defraud the government by $5 billion over the past 5 years (Source 2).

The Supreme Court is due out with their final decision very soon. They are predicted to rule against the mandate and uphold the rest of the law.

Sources:

1. http://www.supremecourt.gov/oral_arguments/argument_transcripts/11-393.pdf

2. https://medaccessforamerica.wordpress.com/2012/05/14/health-insurers-fined-4-3-billion-for-medicare-fraud-and-other-fraud-violations/

U.S. Debt Committee Proposes 20-30% Cuts to Medicare and Medicaid

November 17, 2011 Leave a comment

The U.S. Congressional Joint Committee on Deficit Reduction has proposed a 20-30% combined cut to Medicare/Medicaid. The committee specifically plans to cut $300 billion from Medicare/Medicaid over the next 10 years. Senators on the U.S. Senate Finance Committee have said that the cuts are necessary and have to be done to get rid of all of the fraud committed by UnitedHealthcare, Humana, Cigna, Aetna, and Blue Cross/Blue Shield. Even if the Committee fails to reach a deal next week, automatic 2% cuts to Medicare/Medicaid will still have a major affect on physician practices and hospitals. Tennessee Hospital Association CEO Craig Becker says “if you’re looking at a 2o percent to 30 percent cut in medicare and medicaid funding, there’s no way some of them can take that.” Mr. Becker is absolutely right. Non-profit facilities will suffer and for-profits will suffer just as much. Tenet has publicly said that the sequestration would result in a $40-$54 million loss on EBITDA (cash flow). United Health Systems has said sequestration would reduce EBITDA  by $36.6 million over the next year. For insurers, they are expecting an impact as well. Even though they are being investigated by the U.S. Senate and DOJ for fraud, they plan to use the cuts as an opportunity to continue their attack on physician reimbursement. UnitedHealthcare, Humana, Aetna, Cigna, Blue Cross/Blue Shield specifically plan to withhold as much reimbursement as possible from physicians in order to preserve profits for their shareholders as a result of the cuts.

In addition, CMS plans to cut physician reimbursement by an additional 27.4% starting January 2012. In October of 2012, CMS will also withhold reimbursement for those physicians and hospitals who have “poor” patient satisfaction survey scores (HCAHPS).

Source: http://www.cnbc.com/id/45325955

Source: http://cms.gov/

U.S. Senate Investigating United Healthcare, Cigna, Aetna for Medicare and Medicaid Fraud

November 10, 2011 3 comments

BREAKING NEWS……………………..

The U.S. Senate is now officially investigating United Healthcare, Cigna, and Aetna for one of the largest fraud schemes yet against the Medicare and Medicaid programs. The amount of fraud is said to be in the hundreds of billions of dollars. The fraud was done on purpose as to rake in billions of profits for the insurers at the demand of company executives and shareholders, according to the U.S. Senate.

In addition, FierceHealthcare is reporting that United Healthcare, Cigna, and Aetna have also been caught in a multi-billion dollar pull-through scheme involving Quest Diagnostics and LabCorp. This scheme specifically involves Quest and LabCorp offering contracts for discounted or below-cost pricing in exchange for in-network physician referrals for lab testing business. The companies have clearly violated the U.S. federal anti-kickback law which protects patients and Medicare/Medicaid beneficiaries from potential influence of financial arrangements on care decisions. (Source: http://www.fiercehealthcare.com/story/senate-probe-aetna-cigna-united-healthcare-quest-lab-corp-alleged-billion-d/2011-11-09?utm_medium=nl&utm_source=internal)

This is only the tip of the iceberg. It has also been reported that Blue Cross/Blue Shield and Humana are also being investigated for a very very similar multi-billion dollar fraud scheme as well.

Stay tuned to here for more on this BREAKING NEWS story.

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