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Posts Tagged ‘Humana’

Humana to Pay $5.1 Million in Rebates for Violating Medical Loss Ratio

July 18, 2012 1 comment

Humana sent this blogger a personal letter today stating that it has violated the Medical Loss Ratio rule of the affordable care act. Under this rule, insurance companies are required to pay a rebate back to their policy holders if 80% of their premium dollars is not spent on medical care.

I live in Tennessee. Humana premiums totaled $30,623,077 and only spent $19,353,784 Million  (63.2%)  when it should have spent $24,498,461 (80%) on medical care. Humana used the extra money for “administrative costs” (i.e. profits for shareholders, executive compensation packages) and it thus missed the MLR by 16.8%. Humana is rebating 16.8% back to policy holders which totals $5,144,676 Million.

If you live In Tennessee and are a Humana policy holder, make sure you check your mailbox. If you wish to opine, please hit the Leave A Comment button.

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Health Insurance Company Scheme Alert: Downcoding

June 28, 2012 Leave a comment

Physicians are finally beginning to drop insurance carriers due to the downcoding “scam” that insurers are using in order to greatly enhance their profits. Downcoding specifically is when an insurer unilaterally decides after services have been rendered to reduce the amount of reimbursements a physician (even hospital) can receive. According to the American Medical Association, most physicians believe this practice is a scam aimed directly at giving insurers as much profit as possible and this specific issue is what physicians complain to the AMA the most about.
_____________________________________________________________________________________

CPT Codes Most Downcoded by Insurance Company:
Code:                                                    Medicare Rate:                                         Usual Downcoding Amount
99205 (new pt office visit)               $213.60
99204 (level 4 new office visit)       $170.47                                                      $43.13
99203 (leve 3 new office visit)         $110.92                                                       $59.55
99202 (level 2 new office visit)        $76.88                                                        $34.04
99201  (level 1 new office visit)        $44.77                                                         $32.11
99215  (level 5 established patient)  $149.60
99214  (level 4 established patient)  $111.39                                                      $38.21
99213  (level 3 established patient)   $74.46                                                      $36.93
99212  (level 2 established patient)   $44.77                                                      $29.69
99211 (level 1 established patient)     $22.39
9234 (outpatient observation)            $142.68
99233 (level 3 hospital progress note)   $108.67                                                $34.01
99232 (level 2 hospital progress note)   $75.78                                                  $32.89
99231 (level 1 hospital follow up)            $42.12                                                  $33.66

Average % difference between usual downcoding amount and normal Medicare rate is 49%.
( Source 2)
—————————————————————————————————————————————— Aetna
————-

– Paid $6,270,000 settlement for downcoding dentist claims  (Source 3)
———————————————————————————–
Blue Cross Blue Shield
————————–
– downcoded Anesthesiologist claims (Source 4)
-downcoded Urologist claims in Kansas (Source 4)
———————————————————————————–
Humana
———————————-
Physician exposes massive  “scam” run by Humana (Source 1)
– Humana underpaid by $108.47 on code 99215 when should have paid $149.60
-Humana underpaid by  $27.13 on code 99213 when should have paid $74.46
————————————————————————————————————

Sources:

1. http://www.wejonesmd.com/Pages/Ins/humana.html
2. http://www.mtbc.com/learningcenter/index.php/steps-your-practice-can-take-to-prevent-downcoding-on-medical-claims/
3. http://articles.baltimoresun.com/2003-08-20/business/0308200151_1_aetna-dentists-dental-association
4. http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center/case-summaries-topic/managed-care-payments.page

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Keywords: medical coding, medical billing, health care insurance, health plan, united healthcare, humana, blue cross blue shield

Health Insurance Companies Fined $767 Million for Recissions (Denials)

June 26, 2012 Leave a comment
Health insurance companies have a “fetish” for denying people access to health care. The only reason they do this is to gain/ save company profits for their shareholders and to pay high compensation packages to executives. This evidence is clear in the raw data posted below. According to the data, insurers have specifically denied 25,871,003 (publicly reported) and have been fined $768,755,406  over the past decade. Unfortunately, the denial by the health insurance companies have caused “murder” 4 times (publicly reported) and had judgments due to the “murders” totaling $131,900,000.  In several instances, health insurance companies denied 21,600 claims just to gain $335,500,000 in profit. As a result, an executive was paid a $20,000 bonus for each person denied. In addition, the overall average denial rate by health insurance companies is 30.2%. For-profit Aetna fined the most for denials by a whopping $325,500,000. Nonprofit Blue Cross Blue Shield fined a whopping $205,957,000.
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Deaths caused by Insurer Denials
———————————————–
Aetna (publicly traded)
# of deaths:  1   (Source 39)
judgments:   $124,500,000  (Source 39, 40)
————————————————————
Cigna (publicly traded)
# of deaths:   1   (Source 36)
————————————————————
Humana (publicly traded)
# of deaths:   1   (Source 37)
judgement:   $7,400,000    (Source 37)
 ————————————————————–
Magellan (publicly traded)
# of deaths:  1    (Source 38)
————————————————————–
Denied in order to save Profit (Evidence!)
———————————————————-
Health Net
Saved  $35,500,000 by denying 1,600 claims. Senior analyst got $20,000 bonus as a result.  (Source 21)
——————————————————————————————————————-
United Healthcare, Blue Cross, Assurant
 Saved  $300,000,000  by denying 20,000 claims  (Source 34)
——————————————————————————————————————————————-
Claims Denied by Insurer
———————————————————————————————————————————–
Assurant
# of claims:  20,500                      (Source 4)
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Blue Cross Blue Shield
# of claims:  10,263,365   (Source 2, 3, 9, 10, 18, 22, 27, 28, 29, 30, 33)
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Health Net
# of claims: 7,619,266        (Source 1, 23, 33)
——————————————————————————
United Healthcare
# of claims: 7,967,872     (Source 6,7, 12, 17, 33)
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Insurer Denial Rates
———————————————————————————————————————
Aetna
denial rate:  13% (Source 33, 35)
———————————————–
Blue Cross Blue Shield
denial rate:  28%   (Source 33, 35)
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Cigna
denial rate:  33%  (Source 33, 35)
———————————————–
Health Net:  30% (Source 33, 35)
———————————————–
Humana:  40%   (Source 35)
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Kaiser
denial rate:  28% (Source 33, 35)
————————————————-
United Healthcare
denial rate:  39.6%  (Source 33, 35)
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Reasons for Denial by Insurer
—————————————
Aetna
denied qualified applicants coverage ( Source 1)
denied stomach cancer treatment (Source 32)
denied mental health, pap smears, mammograms, pediatric care (Source 41)
————————————————————————————————————————————-
Amerigroup
denied pregnant women on Medicaid access to care (Source 20)
failed to allow pregnant women to enroll in Medicaid (Source 20)
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Blue Cross Blue Shield
denied coverage to newborns (Source 1)
denied access to emergency care (Source 2, 3)
denied prosthetic legs (Source 8)
denied seniors access to drugs (Source 9)
denied anorexia treatment (Source 10)
denied routine colonoscopy (Source 11)
denied treatment for glutaric academia (Source 12)
denied mental health coverage (Source 18)
denied chemotherapy, physical therapy (Source 19)
denied people when they got sick (Source 22)
denied people when they got sick (Source 24)
denied sick children coverage     (Source 26)
denied women access to contraceptives (Source 27)
denied women coverage due to breast cancer diagnosis (Source 28)
denied women access to contraceptives (Source 29)
denied emergency room claims (Source 30)
denied pediatric cardiac lead tests (Source 31)
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Cigna
inappropriate denials  (Source 1)
denied liver transplant, patient died (Source 14)
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Conseco
improper denials (Source 1)
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Coventry
denied Medicaid patients drug needed by pregnant women (Source 1)
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Health Net
denied qualified claims  (Source 1)
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Kaiser
denied patients access to emergency care, resulted in 3 deaths (Source 2)
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Qualmed
denied patients access to emergency care (Source 2)
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United Healthcare
denied patient claims for emergency care (Source 2)
denied surgeons from scheduling legitimate surgeries (Source 6)
denied children access to pediatric care (Source 6)
denied patients with pre-existing conditions (Source 7)
improperly denied qualified claims  (Source 13)
denied anesthesiology claims  (Source 16)
denied qualified physician claims (Source 17)
————————————————————————————————————————————-
Fines for Denial by Insurer
————————————————————————————————————————————-
Aetna
Fined $327,055,000 (Source 1, 32, 39, 40, 41)
——————————————————————————–
Amerigroup
Fined $162,000,000  (Source 20)
——————————————————————————
Blue Cross Blue Shield
Fined $205,957,000 million   (Source 1,2,3,10,15,19,22,24,26,27,28,29,30)
—————————————————————————————————–
Cigna
Fined $400,000    (Source 1)
—————————————————-
Conseco
Fined $500,000  August 2009 (Source 1)
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Fortis
Fined $15,000,000   (Source 5)
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Health Net
Fined $25,000,000  (Source 23)
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HMO Colorado
Fined $252,500     (Source1)
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Humana
Fined $7,400,000  (Source 37)
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Kaiser
Fined $1.1 million    June 2002 (Source 2)
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QualMed
Fined $25,000  (Source 2)
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United Healthcare
Fined $24,065,906   May 2009  (Source 1,6,7,12,17)
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Sources:
24. http://articles.latimes.com/2006/sep/22/business/fi-revoke22

41. http://www.mass.gov/ago/news-and-updates/press-releases/2012/2012-06-27-aetna-life-insurance.html
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Keywords:

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
————————————————————————————————————————-
Affinity
# of State Fines:   5
Total State Fines:  $30,900  (Source 1
—————————————————————————————————————————————
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
—————————————————————————————————————————————
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
——————————————————————————————————————————————-
Community Choice
# of State Fines:  2
Total State Fines:  $10,300   (Source 1
——————————————————————————————————————————————-
Community First Health Plans
# of State Fines:    1
Total State Fines:  $200,000    (Source 1
——————————————————————————————————————————————-
Community Health Plans of NY, Washington
# of State Fines:    4
Total State Fines:  $1,005,200  (Source 1
——————————————————————————————————————————————-
Community Premier Plus
# of State Fines:    1
Total State Fines:  $1,200    (Source 1
——————————————————————————————————————————————-
Fidelis
# of State Fines:    5
Total State Fines:  $10,100  (Source 1
——————————————————————————————————————————————-
FreeState
# of State Fines:    1
Total State Fines:  $7,500  (Source 1
——————————————————————————————————————————————-
HM Health Insurance
# of State Fines:   1
Total State Fines:  $500 (Source 1
——————————————————————————————————————————————-
Group Health Cooperative
# of State Fines:    15
Total State Fines:  $57,050 (Source 1
——————————————————————————————————————————————-
Health Services Med Corp
# of State Fines:    1
Total State Fines:  $7,300 (Source 1
——————————————————————————————————————————————-
Healthcare Underwriters Mutual
# of State Fines:    1
Total State Fines:  $9,750  (Source 1
——————————————————————————————————————————————-
HealthNow (Medicare Advantage)
# of State Fines:    12
Total State Fines:  $1,170,300 (Source 1
——————————————————————————————————————————————-
Health Plus
# of State Fines:    3
Total State Fines:  $75,200  (Source 1
——————————————————————————————————————————————-
Healthsource plan of NY/NJ
# of State Fines:    2
Total State Fines:  2,200 (Source 1
——————————————————————————————————————————————-
Heritage Provider Network
# of State Fines:    2
Total State Fines:  $294,000  (Source 1
——————————————————————————————————————————————-
HM Health Insurance
# of State Fines:   1
Total State Fines:  $500 (Source 1
——————————————————————————————————————————————-
Hometown Health Plan
# of State Fines:    1
Total State Fines:   $25,000 (Source 1
——————————————————————————————————————————————-
Indemnity Insurance Company
# of State Fines:    1
Total State Fines:  $1,800 (Source 1
——————————————————————————————————————————————-
Independent Health Association
# of State Fines:   5
Total State Fines:  $49,775 (Source 1
——————————————————————————————————————————————
Inland Empire
# of State Fines:    1
Total State Fines:  $2,500  (Source 1
——————————————————————————————————————————————-
Inter Valley
# of State Fines:    1
Total State Fines: $7,500   (Source 1
——————————————————————————————————————————————-
JMH Health Plan
# of State Fines:    1
Total State Fines:  $25,000 (Source 1
——————————————————————————————————————————————-
Kaiser Foundation Health Plans
# of State Fines:    13
Total State Fines:  $792,800 (Source 1
——————————————————————————————————————————————-
Lifewise Health Plan
# of State Fines:    1
Total State Fines:  $1,250 (Source 1
——————————————————————————————————————————————-
Managed Health Network
# of State Fines:    2
Total State Fines:  90,000  (Source 1
——————————————————————————————————————————————-
Mayo Health Plan
# of State Fines:    1
Total State Fines: $25,000  (Source 1
——————————————————————————————————————————————-
Med Mutual of Ohio
# of State Fines:    1
Total State Fines:  $100,000 (Source 1
——————————————————————————————————————————————-
Mercy Health Plans
# of State Fines:    1
Total State Fines:  $100,600 (Source 1
——————————————————————————————————————————————-
Molina
# of State Fines:    1
Total State Fines:  $5,000 (Source 1
——————————————————————————————————————————————-
MVP Health Plan
# of State Fines:    3
Total State Fines: $35,000  (Source 1
——————————————————————————————————————————————-
Promina Health Plan
# of State Fines:    1
Total State Fines: $81,635  (Source 1
——————————————————————————————————————————————-
Providence Health Plan
# of State Fines:    2
Total State Fines:  $3,750 (Source 1
——————————————————————————————————————————————-
Sharp Health Plan
# of State Fines:    1
Total State Fines:  $20,000  (Source 1
——————————————————————————————————————————————-
Sloans Lake
# of State Fines:    1
Total State Fines:  $156,750 (Source 1
——————————————————————————————————————————————-
St. Barnabus (Partners in Health)
# of State Fines:    1
Total State Fines:   $1,300 (Source 1
——————————————————————————————————————————————-
St. Joseph’s Care Management
# of State Fines:    1
Total State Fines:  $33,538 (Source 1
——————————————————————————————————————————————-
SummaCare
# of State Fines:    1
Total State Fines:   $125,000 (Source 1
——————————————————————————————————————————————-
Unicare Life
# of State Fines:    6
Total State Fines:  $1,533,426 (Source 1
——————————————————————————————————————————————-
Univera / Health Plan Inc (NY)     NP
# of State Fines:    2
Total State Fines:  $24,550 (Source 1
——————————————————————————————————————————————-
Vytra
# of State Fines:   9
Total State Fines:  $483,800 (Source 1
——————————————————————————————————————————————-
For-Profit
—————————————————————————————————————-
Aetna  (Public Traded)
# of  State Fines:     31
Total State Fines:  $8,262,982  (Source 1
——————————————————————————————————————————————-
American Heritage Life (AllState, Publicly Traded)
# of State Fines:  2
Total State Fines: Fined $264,765  (Source 1
——————————————————————————————————————————————-
American Medical Life
# of State Fines:     1
Total State Fines $1,000       (Source 1
——————————————————————————————————————————————-
Amil International Insurance Company
# of State Fines:   2
Total State Fines  $196,543  (Source 1
——————————————————————————————————————————————-
Alta Health and Life
# of State Fines    1
Total State Fines: $250  (Source 1
——————————————————————————————————————————————-
Avemco Insurance
# of State Fines:   2
Total State Fines: $269, 729  (Source 1
——————————————————————————————————————————————-
Beacon Health Plan
# of State Fines: 1
Total State Fines: $50,000    (Source 1
——————————————————————————————————————————————-
Capitol American Life
ERISA Settlement:  $6,826,000 (Source 6
——————————————————————————————————————————————-
Careplus
# of State Fines: 4
Total State Fines:  $28,345  (Source 1
——————————————————————————————————————————————-
Central Reserve Life
# of State Fines:  2
Total State Fines:   $811,513 (Source 1
——————————————————————————————————————————————-
CHA HMO
# of State Fines:  1
Total State Fines:  $43,750   (Source 1
——————————————————————————————————————————————-
Cigna (Publicly Traded)
# of State Fines:    26
Total State Fines:  $4,954,534 (Source 1
ERISA Settlement:  $954,000  (Source 6
——————————————————————————————————————————————-
Combined Insurance Company of America of Illinois
# of State Fines:  1
Total State Fines:  $30,000   (Source 1
——————————————————————————————————————————————-
Conseco Medical Insurance Company
# of State Fines:    3
Total State Fines:    $1,820,610  (Source 1
ERISA Settlement: $9,975,000   (Source 6
——————————————————————————————————————————————-
Continental Assurance
# of State Fines:    3
Total State Fines:   $161,212   (Source 1
——————————————————————————————————————————————-
Coventry
# of State Fines:  1
Total State Fines:  $10,000  (Source 1
——————————————————————————————————————————————-
CVS
ERISA Settlement: $3,000,000  (Source 6
——————————————————————————————————————————————-
Dental Benefit Providers Maryland
# of State Fines:    2
Total State Fines:   $80,000  (Source 1
——————————————————————————————————————————————-
Excellus
# of State Fines:    8
Total State Fines:   $36,400  (Source 1
——————————————————————————————————————————————-
Florida 1st Health Plan
# of State Fines:    1
Total State Fines:  $25,000  (Source 1
——————————————————————————————————————————————-
Fortis Insurance
# of State Fines:   3
Total State Fines:  $1,410,055  (Source 1
——————————————————————————————————————————————-
Foundation Health
# of State Fines:    1
Total State Fines:  $50,000 (Source 1
——————————————————————————————————————————————-
FreeState
# of State Fines:    1
Total State Fines:   $75,000 (Source 1
——————————————————————————————————————————————-
Great West Healthcare
# of State Fines:    4
Total State Fines:  $2,323,669  (Source 1
——————————————————————————————————————————————-
Guardian Life
# of State Fines:    6
Total State Fines:  $1,440,305 (Source 1
——————————————————————————————————————————————-
Hartford Casualty Insurance Company
# of State Fines:    1
Total State Fines:  $20,000  (Source 1
——————————————————————————————————————————————-
Health Care Plan of NY
# of State Fines:    1
Total State Fines:   $20,500 (Source 1
——————————————————————————————————————————————-
Health Insurance Plan of NY
# of State Fines:    10
Total State Fines:  $351,350 (Source 1
——————————————————————————————————————————————-
Health Net
# of State Fines:    9
Total State Fines:  $521,700 (Source 1
ERISA Settlement: $215,000,000  (Source 6)
——————————————————————————————————————————————-
Health Options
# of State Fines:    1
Total State Fines:  $50,000  (Source 1
——————————————————————————————————————————————-
Healthplan Southeast
# of State Fines:    1
Total State Fines: $50,000   (Source 1
——————————————————————————————————————————————-
HMO Colorado
# of State Fines:  1
Total State Fines:  $252,500  (Source 1
————————————————————————————————————————————–
Human Affairs
# of State Fines:    1
Total State Fines:  $5,500 (Source 1
————————————————————————————————————————————-
Humana (Publicly Traded)
# of State Fines:    9
Total State Fines:  $2,879,113 (Source 1
ERISA Settlement:  $58,000,000  (Source 8
—————————————————————————————————————————————
LifeGuard
# of State Fines:    1
Total State Fines:  $40,000 (Source 1
——————————————————————————————————————————————-
Magellan
# of State Fines:    2
Total State Fines:  $450,000 (Source 1
——————————————————————————————————————————————-
Meco Health Solutions
ERISA Settlement: $42.5 million
——————————————————————————————————————————————-
Med Insurance Company of Ohio
# of State Fines:    1
Total State Fines:  $60,000 (Source 1
——————————————————————————————————————————————-
Mega Life and Health Insurance Company
# of State Fines:    3
Total State Fines:  $875,000  (Source 1
——————————————————————————————————————————————-
MetLife Insurance Company
# of State Fines:   5
Total State Fines: $1,343,428  (Source 1
——————————————————————————————————————————————-
MDNY
# of State Fines:    9
Total State Fines:  $185,650  (Source 1
——————————————————————————————————————————————-
Merit  Behavioral
# of State Fines:    1
Total State Fines:  $7,500  (Source 1
——————————————————————————————————————————————-
Mid-South Insurance Company
# of State Fines:  1
Total State Fines:  $51,850 (Source 1
——————————————————————————————————————————————-
Mid-West National Life
# of State Fines:    2
Total State Fines:  $140,500  (Source 1
——————————————————————————————————————————————-
New England Life
# of State Fines:    1
Total State Fines:  $41,500 (Source 1
——————————————————————————————————————————————-
New York Life Insurance
ERISA Settlement: $14,000,000  (Source 6)
——————————————————————————————————————————————-
NYL Care
# of State Fines:   5
Total State Fines:  $1,092,050 (Source 1
——————————————————————————————————————————————-
Oriska Insurance
# of State Fines:    1
Total State Fines:  $3,900 (Source 1
——————————————————————————————————————————————-
Oxford Health Plans
# of State Fines:    13
Total State Fines:  $5,046,674 (Source 1
——————————————————————————————————————————————-
Pacific Life and Annuity Company
# of State Fines:    3
Total State Fines: $3,530,579  (Source 1
——————————————————————————————————————————————-
Physicians Healthcare Plans
# of State Fines:    2
Total State Fines:  $78,300 (Source 1
——————————————————————————————————————————————-
Principal Life Insurance Company
# of State Fines:    2
Total State Fines:  $704,856 (Source 1
——————————————————————————————————————————————-
Protective Life Insurance Company
# of State Fines:    2
Total State Fines:  $152,780 (Source 1
——————————————————————————————————————————————-
Prudential
# of State Fines:    6
Total State Fines:  $216,000  (Source 1
——————————————————————————————————————————————-
Qualmed Washington
# of State Fines:    1
Total State Fines:  $250,000 (Source 1
——————————————————————————————————————————————-
Renaissance Health and Life
# of State Fines:   1
Total State Fines:  $1,750 (Source 1
——————————————————————————————————————————————-
Rite Aid
ERISA Settlement: $67,600,000 (Source 6)
——————————————————————————————————————————————-
Safeguard Health Plans
# of State Fines:    3
Total State Fines:  $239,339 (Source 1
——————————————————————————————————————————————-
Sierra Health / Texas Health Choice Companies
# of State Fines:    3
Total State Fines:  $1,437,450 (Source 1
——————————————————————————————————————————————-
Systemas Medicos
# of State Fines:    1
Total State Fines:  $7,500  (Source 1
——————————————————————————————————————————————-
Trustmark Insurance Company
# of State Fines:    2
Total State Fines: $595,676  (Source 1
——————————————————————————————————————————————-
United American Insurance Company of McKinney
# of State Fines:   1
Total State Fines:   $190,000 (Source 1
——————————————————————————————————————————————-
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
——————————————————————————————————————————————-
Vista Health Plan
# of State Fines:    1
Total State Fines:  $50,000 (Source 1
——————————————————————————————————————————————-
Well Care
# of State Fines:    6
Total State Fines:  $147,100 (Source 1
————————————————————————————————————
 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%
—————————————————————————
————————————————————————————————————————–
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

Breaking News: Health Insurance Companies to Uphold Health Reform Provisions

June 14, 2012 Leave a comment

Breaking News…………………………………….

The for-profit health insurance companies of UnitedHealthcare, Aetna, and Humana have come out saying that they will uphold provisions in the Affordable Care Act regardless of how the U.S. Supreme Court rules later this month. Key provisions they especially will uphold include: keeping kids on parents insurance until age 26, covering preventive services,  maintaining independent process of claim denials, and no lifetime limits on coverage. The not-for-profit insurers are already planning to uphold provisions as well. The for-profit companies have decided to take this position only because they see the way this can greatly enhance profit for their shareholders and that they definitely do not want to miss out on anything that will  maximize profit.

Press Releases of the for-profits announcing their position on this matter can be read here:

http://press.humana.com/news/humana/20120611006392/en/Humana-Voluntarily-Preserve-Key-Health-Care-Reform

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