The Humana insurance company recently filed a lawsuit against one of the drug testing companies with whom they do business. They claim in the lawsuit that the company, a medication monitoring service provider called Ameritox, knowingly received several million dollars from Humana by issuing insurance claims that were largely false in nature. These fraudulent claims were mostly comprised of claims for urine drug tests.
Humana is alleging that Ameritox attempted to maximize their profits by issuing claims for urine testing when it wasn’t covered by the policy issued to the company. They would also make claims for urine testing when the tests were not necessary, therefore the only logical reason the company would perform them is to create a profit. Ameritox does use urine testing to some degree since they are a drug-use monitoring service between doctors and their patients, but Humana claims the majority of the tests were performed for no reason, or weren’t covered by the plan.
The lawsuit was filed in the beginning of August in 2016. The suit was filed in the United States District Court in North Carolina. The state of North Carolina was chosen because Ameritox has a facility where they conduct testing in the state. The company has not yet filed a counter suit, but a spokesperson for Ameritox said they vigorously disagree with the allegations. They believe each test they performed was necessary and was covered under their plan. A counter suit is certainly expected from them.
Humana Investigates Internally
The lawsuit is the result of an internal investigation that Humana started conducting when it first discovered strange activity within Ameritox’s billing practices. The insurance company stated that they stopped paying claims to Ameritox once the full extent of the activity was uncovered. They attempted to contact the company multiple times to request proof of the necessity of the urine tests, yet they never received proper documentation. The few medical records that they did receive were either incomplete or showed no need for testing.
Humana stated that of the claims Ameritox submitted in 2015, 90 percent were non-payable since they weren’t necessary or never occurred to begin with. As with the earlier cases, medical documentation was absent for nearly all the claims. Even though Humana stopped paying claims to Ameritox, the company continued to send Humana claims for the tests they knew weren’t being reimbursed.
Humana is an insurance company based out of Louisville, Kentucky. The lawsuit they filed against Ameritox is for an unreleased amount of damages, but one could speculate the amount is in the millions. They are not only seeking compensatory damages, which are damages purely designed to repay some debt that built up as a result of the case in question, but they are also seeking punitive damages. Compensatory damages would include the reimbursement for the fraudulent claims Humana paid out to Ameritox before the insurance company uncovered their unusual activity, and punitive damages seek to act as a punishment toward the party at fault.
Ameritox has expressed its own level of disappointment over the way the situation is playing. Both sides believe themselves to be in the right, so court is unavoidable. They have yet to be able to come to any sort of resolution on their own terms. Ameritox may very well be in the right since their service is defined by drug monitoring, and for the problems with prescription drug addiction in the United States, perhaps frequent testing is more necessary than Humana cares to admit. The court will have to decide not only if the tests were medically necessary, but whether or not those tests were actually covered under their policy with Humana.
Learn more about Drug Lawsuits.