Humana Medical Plan, Inc., has agreed to pay $3.2 million to settle a dispute with the Florida Agency for Health Care Administration about whether the Medicaid HMO properly reported suspected fraud or abuse by health providers, according to documents filed this week in the state Division of Administrative Hearings.
Humana began a legal challenge last year after AHCA sought to impose nearly $3.4 million in fines.
Humana contended that AHCA was incorrectly applying a state law and that the HMO had reported potential fraud or abuse within a required 15 days of detection.
In the settlement, neither side admitted wrongdoing or errors.
The agreement also says Humana has “established and implemented procedures and practices that, as of Oct. 1, 2011, have been assuring and will continue to ensure that all instances of suspected or confirmed fraud or abuse will be reported to the agency within 15 days after detection … as that provision (of state law) is understood by the agency, rather than as previously understood by the plan.”
