’Til Death (or Lack of Profits) Do Us Part Healthcare: Humana’s Debut in Hospice

As nonprofits ceased to dominate the hospice field in recent years and for-profits became the majority players—according to the New York Times, for-profits controlled 63 percent of the sector as of 2013— quality of care has arguably decreased while fraud and overbilling has increased. NPQ has been following the changes to the hospice industry for years, and while it is possible these issues plaguing hospice can be chalked up to correlation, not causation, it seems more probable that the hospice industry’s lack of standards coupled with its high profit potential make it ripe for fraud by dishonest providers.

With profit margins as high as 16 percent, it comes as no surprise that for-profit companies want a piece of the pie and have eagerly joined the industry. The New York Times estimates that since the year 2000, the number of for-profit hospice providers has “more than quadrupled.” In this time, dozens of lawsuits have found for-profit outfits guilty of a wide variety of infractions ranging from inappropriately accepting patients into hospice, to substandard care, overbilling, and even causing untimely death. Throughout it all, hospice providers have received “slap on the wrist” penalties with no real changes to the industry occurring.

Part of the reason there are few changes being made to the industry is that the field itself is rather subjective. In the face of terminal illness, some physicians and patients opt for aggressive treatment, whereas others do not. In some cases, it seems to be as much a personal decision as it is a medical one. While the National Hospice and Palliative Care Organization has put out a tip sheet on compliance, even this indicates that “each patient and his or her symptoms will differ.” The subjective nature of the field does not lend itself to strict standards and, to reiterate previous NPQ conclusions, may be another reason that hospice should stay within the nonprofit sector. Without a profit motive, nonprofit organizations are better able to focus on quality care and keep the patients’ best interest front and center.

With Humana entering the game, now there’s a new player with added cause for concern. Humana is partnering with private investors to purchase two hospice providers, Kindred and Curo. Both providers have already faced steep penalties: Kindred for overbilling and Curo for providing kickbacks to physicians referring patients to its facilities. Humana’s foray into hospice represents one of the first insurers to do so and, as one of the largest private Medicare agencies, they stand to reap in huge profits as they work with patients from health through death.

What is particularly concerning about Humana’s involvement is that Humana would benefit from its customers opting for hospice over expensive end-of-life treatment. The New York Times article explains:

“An insurer that can steer patients towards its hospice has ‘better control,’ said Rob Smith, an analyst with Capital Alpha Partners. After giving consent, dying patients can be shifted to the hospice program, and while an insurer would lose out on money it received from Medicare to cover that person, a company like Humana could count on the revenue generated by its hospice business. ‘Your other pocket is filled by Medicare,’ he said.”

The same issues plaguing the hospice industry stand to be exacerbated in the case of Humana unless the company sets its own high standards for hospice eligibility. When hospice providers operate independently, they still need to convince patients to come to their facility. That would explain why providers such as Curo provided incentives for physician referrals. With Humana dominating private Medicare and owning its own hospice outfits, they can technically funnel patients into their facilities.

With Humana entering the hospice field, it’s only a matter of time before other insurers jump on board as well. This idea of ’til-death-do-us-part healthcare from for-profit entities smells incredibly fishy and opens up an already problematic industry to even more duplicitous behavior. Meanwhile, patients and families are in their most vulnerable position and need help that is not clouded by greed. While the hospice field seems to be moving away from nonprofit hospice providers, it stands that this is the best model for the industry.—Sheela Nimishakavi

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’Til Death (or Lack of Profits) Do Us Part Healthcare: Humana’s Debut in Hospice

A Breach of Trust: Humana Used Obamacare as Club Against Policyholders

A federal class action claims Humana jacked up its health insurance premiums to coincide with Obamacare, while failing to give policy holders a reasonable way to cancel policies.

Lead plaintiff Daniel L. Doyle sued Kentucky-based Humana on Tuesday.

Doyle says he received a letter from Humana in August stating that his policy would be canceled on Dec. 31, 2013 and replaced with a new one, to coincide with the Affordable Health Care Act.

The premium for the new policy would be $395.97 a month, significantly (73%) higher than the $229.30 a month Doyle had been paying.

Doyle says he received another letter on Oct. 24, 2013 with clarification to the August letter. He then found a better policy with another provider and wanted to cancel his policy with Humana.

"On or about November 20, 2013, Mr. Doyle was notified that he had new insurance coverage with Blue Cross Blue Shield beginning December 1, 2013," the complaint states.

"Plaintiff then immediately attempted to contact Humana to cancel his policy but was unable to reach anyone who could assist him to cancel.

"Plaintiff again tried to cancel two to three days later. He again was unable to reach anyone at Humana who could assist him in cancelling his policy.

 "On numerous occasions, Mr. Doyle unsuccessfully attempted to cancel his policy by calling the toll-free number listed in the October 24, 2013 letter. Whenever Mr. Doyle called the toll-free number, he encountered an automated call system that would not enable him to speak to a person.

"Frustrated with the significant hold times and inability to speak with a human being, Mr. Doyle contacted his Blue Cross representative, who provided a fax number for Humana which he was unable to locate on Humana's website.

"On or about November 25, 2013, Mr. Doyle sent a facsimile to Humana providing Human with written cancellation of his policy.

"Humana refused to respond to Mr. Doyle's written cancellation request.

The class consists of all Humana policyholders in the United States who have been billed for insurance premiums on policies which were canceled by Humana on or before Dec. 31, 2013 and/or after the class member tried to cancel the policy.

Doyle seeks class certification, wants Humana enjoined from continuing its practices, disgorgement of profits from the scheme and actual and punitive damages for violations of the Kentucky Consumer Protection Act.

Humana is one of the largest health insurers in the country, with more than $13 billion in revenue in 2013, according to the lawsuit.
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A Breach of Trust:  Humana Used Obamacare as Club Against Policyholders

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A Breach of Trust

Minnesota wants CMS to investigate Humana’s Medicare Advantage plans

Minnesota Attorney General Lori Swanson is asking the CMS to investigate Medicare Advantage plans offered by Humana and has presented regulators with more than 25 affidavits of complaints from beneficiaries.

The affidavits allege, for instance, that Humana denied reimbursement for services that it is required to cover for all Medicare beneficiaries—including diagnostic ultrasounds, mammograms and care in a skilled-nursing facility for a stroke patient.

The letter also said, among other complaints, that the Louisville, Ky.-based insurer created confusion by not adequately disclosing which providers were in-network and does not comply with required appeals processes.

The complaints come at a time when the popularity of Medicare Advantage plans has been escalating. And Minnesota has the highest percentage of Medicare beneficiaries enrolled in an MA plan, at 49%—compared with 28.8% of beneficiaries nationwide, the letter said. Humana has 17% of the Medicare Advantage market in Minnesota, according to Swanson’s office.

Swanson wrote that she was asking the CMS to pursue an investigation because states do not have the authority to enforce Medicare Advantage plan rules and make benefit determinations.

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Minnesota wants CMS to investigate Humana’s Medicare Advantage plans

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A Breach of Trust

A Breach of Trust: WWII Veteran Wrongfully Denied Coverage

A WWII Veteran known for his integrity and love of family, he worked hard his entire life to give them the best upbringing and memories he possibly  could.  He taught his young ones to always be honest and to keep their word without hesitation.  To him, that was ultimately important and his example served well.

Little did he know, as he raised his children in honor and honesty, that  one day he would be the victim of a breach of trust by one, who should  have been his champion, during a devastating medical crisis.  He trusted  and he was betrayed.  Never again shall his life be as once promised.

 Deceit won the battle that day, but the truth was not conquered. 

Truth fights on and strives to win the war against those who deny care for  profit and because they can.

Truth and knowledge will bring the deceit and trickery into the light  and hopefully prevent others from being denied proper care at critical  moments.  People deserve better than that.  People should be able to  trust the caregivers and providers.  People deserve the chance to  recover and live on in dignity and with purpose to whatever degree is theirs to behold.  People should and it is time eyes are opened and the truth be seen by a population unaware.  It’s time people rather than  profits trump and honesty prevail.

A Breach of Trust is never acceptable and it shan’t be silently tolerated! 

Be intolerant — add your voice in objection to deceit and trickery that wrongfully denies coverage!

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A Breach of Trust:  Wrongfully Denied Coverage

Recommended Website: A Breach of Trust: WWII Veteran and Wife

Humana Inc., one of the nation’s largest managed-care companies, was accused in a Federal lawsuit yesterday of misleading health plan members by failing to disclose financial incentives to doctors and case reviewers intended to keep down costs by limiting or denying care.

The suit, filed on behalf of workers in Florida and Texas, asked a United States District Court in Miami to certify a class action on behalf of more than six million customers of Humana health plans nationwide. The suit seeks triple damages under the Federal anti-racketeering law. No amounts were specified.

The plaintiffs say they did not get the health coverage that they thought they were selecting because the company did not disclose incentives to doctors to deny care.

Joseph Sellers, a Washington lawyer who represents the plaintiffs in Miami, said the suit did not question whether managed care was a good idea or whether cost should be a factor. Instead, the suit contends that there was a ”breach of trust” because plan members thought that medical guidelines would solely determine their treatment.

Source:
Humana Sued in Federal Court Over Incentives for Doctors