Currently leadership is aware of many Medicaid members across all state having more than one active Medicaid plan in more than one state. Reports/dashboards are available that capture this but leadership turns their head "it's beyond our scope" . Yet Humana is getting capitated payments PMPM (per member per month) from both states for the same member. It's only a matter of time before there is an audit by OIG. I understand that it's up to the members responsibility to cancel coverage in one state before applying in another state but surely it should also be the responsibility of the MCO to detect and report these to the individual states to stay in compliance!
7 replies (most recent on top)
@2m3
Nope.
@OP you need to report and take status ASAP as a whistle blower. Humana's tower of power is tumbling down before your very eyes. I took early retirement due to the ethical concerns and didn't report when I had the opportunity with my hands on the very report you're speaking of!!
@h4 you are joking, right?
Sounds like leadership/management post on this post real quick at the very bottom. Funny how they are throwing the blame when employees themselves are saying they have seen it first-hand.
Yep, good ole corrupt Humana. I’ve seen some real shady stuff over the past 15 years. Anyone that thinks Humana is saint like better schedule their lobotomy ASAP.
It IS Humana, regulatory weighs out the cost/benefit analysis and Humana is raking in millions on this scheme. 10 years of working here has been eye opening, for sure.
Pretty sure you are thinking of UHC. Our regulatory and compliance would never let us get to this pt.