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Corporate conductSettlement
Humana Inc agreed to pay $90 million to the federal government to settle a whistleblower lawsuit alleging fraudulent Medicare Part D bids
Last week, Humana Inc (NYSE:HUM) agreed to pay $90 million to the federal government to settle a whistleblower lawsuit alleging fraudulent Medicare Part D bids.
Last week, Humana Inc (NYSE:HUM) agreed to pay $90 million to the federal government to settle a whistleblower lawsuit alleging fraudulent Medicare Part D bids.
This article Whistleblower Lawsuit Against Humana: Settles Medicare Part D Fraud Allegations For $90M originally appeared on Benzinga.com
Whistleblower Lawsuit Against Humana: Settles Medicare Part D Fraud Allegations For $90M
Insurer Humana has said it will pay $90 million to resolve a False Claims Act case alleging that the company submitted fraudulent bids to the Centers for Medicare and Medicaid Services to secure Part D prescription drug contracts between 2011 and 2017.
The lawsuit, filed in the US District Court in western Kentucky, is led by two people who had a Humana Medicare Advantage Plan policy and said they were wrongfully denied needed and covered care, harming their health and finances.
Humana also using AI tool with 90% error rate to deny care, lawsuit claims - Ars Technica
The lawsuit accuses Humana of cutting payments prematurely for rehabilitative care based on nH Predict's "highly inaccurate" recovery predictions, favoring them over doctors' recommendations.
Humana sued for allegedly using AI for Medicare Advantage denials | Healthcare Finance News
(formerly known as Anthem), and Humana Inc. — and three large insurance broker organizations — eHealth, Inc. and an affiliate, GoHealth, Inc., and SelectQuote Inc. The United States alleges that from 2016 through at least 2021, the defendant insurers paid hundreds of millions of dollars in illegal kickbacks to the defendant brokers in exchange for enrollments into the insurers’ Medicare Advantage plans.
On October 18, 2024, Humana Inc., along with co-plaintiff Americans for Beneficiary Choice, filed suit against the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, Xavier Becerra in his official capacity as Secretary, and Chiquita Brooks-LaSure, in her official capacity as Administrator, in the United States District Court, Northern District of Texas, Fort Worth Division, seeking a determination that they violated the Administrative Procedure Act in administering the Medicare Advantage and Part D Star Ratings program.
Corporate conductSettlement
Humana agreed to pay $1.8 million for allegedly violating the Civil Monetary Penalties Law
Humana Agreed to Pay $1.8 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Prescription Drug Event Claims that Improperly Claimed Sales Tax | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services.
Humana Agreed to Pay $1.8 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Prescription Drug Event Claims that Improperly Claimed Sales Tax | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services
Corporate conductConfirmed
The Federal Trade Commission initiated a merger investigation
The documented action involving Humana, Inc. concerns FTC File No. 161-0026.
81(a)(5), for an order requiring Respond- ent Humana, Inc. to comply in full with the April 10, 2017 subpoena duces tecum issued to it in a merger investigation being conducted by the FTC (FTC File No. 161-0026).
Corporate conductConfirmed
Humana enters merger with Aetna
Humana entered into a merger agreement with Aetna on July 2, 2015.
Aetna and Humana entered into a merger agreement on July 2, 2015.
Corporate conductAllegation
Humana filed a response in opposition to the stay
On that same day, Humana filed a response in opposition to the stay, asking that it be lifted,7 and on September 11 a response in opposition to Mylan’s allegations of a conflict of interest disqualifying Special Master Stengel.8 Mylan’s motions and Humana’s responses were supported by several exhibits.
On that same day, Humana filed a response in opposition to the stay, asking that it be lifted,7 and on September 11 a response in opposition to Mylan’s allegations of a conflict of interest disqualifying Special Master Stengel.8 Mylan’s motions and Humana’s responses were supported by several exhibits.
Corporate conductConfirmed
Humana receives $3,100,900 civil penalty notice
Centers for Medicare & Medicaid Services provides notice to Humana of a $3,100,900 civil money penalty for specific Medicare Advantage-Prescription Drug and Prescription Drug Plans.
§§ 422.752(c)(1), 422.760(c), 423.752(c)(1), and 423.760(c), the Centers for Medicare & Medicaid Services (CMS) is providing notice to Humana, Inc. (Humana) that CMS has made a determination to impose a civil money penalty (CMP) in the amount of $131,660 for Medicare Advantage-Prescription Drug (MA-PD) and Prescription Drug Plan (PDP) Contract Numbers H0028, H0292, H0473, H1019, H1036, H1468, H1951, H3533, H4007, H4141, H4461, H5216, H5525, H5619, H5970, H6622, H7284, H7621, H8087, H8908, H9070, R0110, R0865, R1390, R3392, R4182, R4845, R5495, R7220, S5552, and S5884.
§ 422.752(c)(1), § 422.760(b), § 423.752(c)(1), and § 423.760(b), CMS has determined that Humana’s violations of Parts C and D requirements directly adversely affected (or had the substantial likelihood of adversely affecting) enrollees and warrants the imposition of a CMP.
§ 422.752(c)(1), § 422.760(b), § 423.752(c)(1), and § 423.760(b), the Centers for Medicare & Medicaid Services (CMS) is providing notice to Humana, Inc. (Humana), that CMS has made a determination to impose a civil money penalty (CMP) in the total amount of $3,100,900 on Medicare Advantage-Prescription Drug (MA-PD) and Prescription Drug Plan (PDP) Contract Numbers: H0028, H0108, H0336, H1019, H1036, H1291, H1406, H1418, H1468, H1510, H1716, H1906, H1951, H2012, H2029, H2486, H2649, H2944, H2949, H3480, H3533, H4007, H4141, H4145, H4461, H4510, H5216, H5415, H5525, H5619, H5970, H6609, H6622, H6859, H8145, H8908, H8953, R5826, S2874, S5552, and S5884.
Privacy & surveillanceConfirmed
Humana Inc. warned that customers in Texas
The documented action involving Humana Inc. concerns personal data.
Humana Inc. warned that customers in Texas and five other states may have had their personal data compromised in a data breach.
Humana said its systems had been accessed by unauthorized users in August due to a “vendor’s software vulnerability.” Upon discovery of the problem, it fixed the software and notified law enforcement.
Privacy & surveillanceConfirmed
Humana receives OAG notification
Humana received a notification from the Office of the Attorney General on March 2, 2026.
HUMANA INC PRIVACY OFFICE 101 E MAIN STREET LOUISVILLE KY 40201 Humana To enroll in credit/identity monitoring with Equifax, please call: 000002 2/5 1-855-833-9162 Or Visit: www.equifax.com/activate Enter your unique Activation Code: <CODE> RE: 1083870 NOTICE OF DATA BREACH Dear<F We are writing to let you know about a recent data security incident that involved some of your personal information.
LOUISVILLE KY 40202 Humana March 19, 2026 SP 01 000002 23253 I 1 ASNGLP RECEIVED 000002 1/5 Office of the Attorney General MAR 2 7 2026 700 W.
LOUISVILLE KY 40202 Humana March 19, 2026 SP 01 000002 23253 I 1 ASNGLP RECEIVED 000002 1/5 Office of the Attorney General MAR 2 7 2026 700 W. Jefferson Street, Suite 210 P.O. Box 83720 CONSUMERISPROTECTION Boise, Idaho 83720-0010 RE: Case # 1083870 NOTICE OF SECURITY INCIDENT Dear Attorney General, The purpose of this letter is to notify your office of a recent security incident that occurred, impacting two (2) Idaho residents.
First, let me state that Humana takes all privacy concerns seriously and is taking appropriate steps to prevent errors such as this in the future. What Happened? On s sm o s n o n H s in August of 2025 leveraging a previously unknown Oracle software vulnerability.
Right now, we have no indication of identity theft or misuse of your Humana accounts as a result of this incident, but we want to tell you what happened and what you can do to further protect yourself in an abundance of caution. What Happened. On September 29, 2025, Humana learned of unauthorized access to certain of Humana's internal systems in August of 2025 caused by a vendor's software vulnerability.
In addition, although we have no indication of identity theft or fraud on your Humana accounts, out of an abundance of caution we are providing you with access to 24 months of credit monitoring and identity restoration services through Equifax at no charge to you.
On September 29, 2025, Humana learned of unauthorized access to certain of Humana’s internal systems in August of 2025 caused by a vendor’s software vulnerability .
Corporate conductSettlement
Humana settlement over public-program fraud
(Humana), headquartered in Kentucky, agreed to pay $411,600 for allegedly violating the Civil Monetary Penalties Law.
(Humana), headquartered in Kentucky, agreed to pay $411,600 for allegedly violating the Civil Monetary Penalties Law.
After it self-disclosed conduct to OIG, Humana Inc. (Humana), headquartered in Kentucky, agreed to pay $411,600 for allegedly violating the Civil Monetary Penalties Law.
Humana Agreed to Pay $411,000 for Allegedly Violating the Civil Monetary Penalties Law by Making False Statements in Support of Meaningful Use Payments | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services