Phillips & Cohen partners Edward Arens and Claire Sylvia discuss the $90 million settlement with Humana in the Louisville Courier Journal.
“The Part D program depends on insurance companies paying their minimum share of drug costs. … Humana shirked its responsibility by telling the government that its plan would cover drug costs that Humana did not actually plan to cover. Our complaint detailed how the government and beneficiaries were left with paying tens of millions of dollars more than Congress intended for years, while Humana pocketed the money as ‘savings,’” Claire Sylvia, a whistleblower attorney and Phillips & Cohen partner who filed the case, said in the release.
Edward Arens, a Phillips & Cohen partner who also represented the whistleblower, said they allege Humana kept two sets of books, “one set that its actuaries prepared for bids Humana submitted to the government and a separate internal set that Humana’s actuaries prepared with Humana’s actual anticipated costs, which Humana used for all its business dealings including its internal budgeting,” according to the release.
“Although Humana asserted in court papers that the predictions underlying its bids were merely estimates about future behavior, they worked in Humana’s favor 100% of the time over seven years and for 245 bids,” Arens said. “The odds that a big insurer would ‘miss’ on an important assumption in the same way that many times in a row are too small to measure.”
Read the entire article, “Humana to pay $90M to federal government to settle whistleblower lawsuit,” Louisville Courier Journal, August 16, 2024.