Humana Stuck With FCA Suit Over Medicare Advantage Billing

By Jeff Overley (April 2, 2015, 6:05 PM EDT) -- A Florida magistrate judge on Wednesday recommended that a False Claims Act whistleblower be allowed to proceed with allegations that Humana Inc. defrauded Medicare Advantage by exaggerating patient illnesses, despite lacking specific examples of bogus billing.

U.S. Magistrate Judge John J. O'Sullivan, who previously found that whistleblower Olivia Graves is not an insider entitled to a relaxed pleading standard, decided that she had floated enough allegations about Humana's conduct to move ahead.

Although Graves did not identify specific instances in which Humana billed Medicare, she did lay out extensive details suggesting the company knew or should have known about suspicious activities...

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