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  2. 'Deny, deny, deny': By rejecting claims, Medicare Advantage ...

    www.aol.com/news/deny-deny-deny-repeatedly...

    Humana, the next largest provider, counts 5.3 million Medicare Advantage customers; during the six months that ended June 30, almost 80% of Humana’s $51 billion in premium revenues came from ...

  3. State retirees caught in middle of contract dispute between ...

    www.aol.com/state-retirees-caught-middle...

    A spokesperson for the health system said “good faith” negotiations have failed due to Humana’s high rate of health claim denials and refusal to set up systems that allow providers to ...

  4. Humana to pay $90M to federal government to settle ... - AOL

    www.aol.com/humana-pay-90m-federal-government...

    Humana has agreed to pay $90 million to the federal government to settle a whistleblower lawsuit under the False Claims Acts.. The lawsuit, filed by Phillips & Cohen LLP on behalf of whistleblower ...

  5. UnitedHealth Group - Wikipedia

    en.wikipedia.org/wiki/UnitedHealth_Group

    On January 15, 2009, UnitedHealth Group announced a $350 million settlement of three class action lawsuits filed in Federal court by the American Medical Association, UnitedHealth Group members, healthcare providers, and state medical societies for not paying out-of-network benefits. This settlement came two days after a similar settlement with ...

  6. Pharmacy benefit management - Wikipedia

    en.wikipedia.org/wiki/Pharmacy_benefit_management

    In the United States, health insurance providers often hire an outside company to handle price negotiations, insurance claims, and distribution of prescription drugs. Providers which use such pharmacy benefit managers include commercial health plans , self-insured employer plans, Medicare Part D plans , the Federal Employees Health Benefits ...

  7. Capitation (healthcare) - Wikipedia

    en.wikipedia.org/wiki/Capitation_(healthcare)

    Provider revenues are fixed, and each enrolled patient makes a claim against the full resources of the provider. In exchange for the fixed payment, physicians essentially become the enrolled clients' insurers, who resolve their patients' claims at the point of care and assume the responsibility for their unknown future health care costs.

  8. Whistleblower Lawsuit Against Humana: Settles Medicare ... - AOL

    www.aol.com/whistleblower-lawsuit-against-humana...

    Last week, Humana Inc (NYSE:HUM) agreed to pay $90 million to the federal government to settle a whistleblower lawsuit alleging fraudulent Medicare Part D bids. The lawsuit, filed by Phillips ...

  9. Cigna abandons pursuit of Humana, plans $10 billion share ...

    www.aol.com/news/us-health-insurer-cigna-scraps...

    A Cigna-Humana combination would have created a company with a value exceeding $140 billion, based on their market values, but was certain to attract fierce antitrust scrutiny.