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Humana Fights AHCA Fines After Suspected Medicaid Fraud

TALLAHASSEE (CBS4)- Humana Medical Plan is challenging nearly $3.4 million in fines that the Florida Agency for Health Care Administration has tried to impose in a dispute about reporting suspected Medicaid fraud, according to a case filed last week in the state Division of Administrative Hearings.

AHCA issued the fines in August, contending that the Humana HMO did not report suspected fraud by Medicaid providers within 15 days of becoming aware of the possible wrongdoing.

The suspected fraud involved such things as doctors providing excessive services, a case record shows.

But Humana argues in the case that it properly reported suspected fraud within 15 days of detection and that AHCA has misinterpreted a law dealing with the issue.

Also, Humana contends it has a "vested interest" in rooting out fraud because it gets paid set amounts of money each month to manage the care of Medicaid beneficiaries.

(©2011 CBS Local Media, a division of CBS Radio Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. The News Service of Florida contributed material for this report)

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