Minnesota's attorney general has asked the federal government to investigate insurance giant Humana for its treatment of Medicare Advantage policyholders in the state.
Medicare Advantage plans, also known as Medicare Part C, are federally-approved plans sold and administered by private insurance companies.
Attorney General Lori Swanson wrote to the head of the centers for Medicare and Medicaid alleging a pattern of wrongdoing by Humana, including denying payment for medical services it's required to cover and not complying with an appeals process.
Complaints, said Swanson, "were coming in from both patients enrolled with this insurance company but also from medical providers" statewide.
A Humana spokesperson said the insurer takes the allegations "very seriously" and is "working to identify the facts."
Nearly half of all Medicare beneficiaries in Minnesota are enrolled in Medicare Advantage plans, the highest percentage of any state in the U.S., though Humana's market share in Minnesota is not clear.
Swanson's letter includes 25 affidavits from patients and medical providers that not only support Swanson's claims but also paint a picture of what Dawn Kern, business office manager at Bigfork Valley Hospital described as "frivolous denials...and lengthy and often fruitless appeal process."
Swanson's letter says two years after Humana preauthorized Medicare-covered home care services for two Bigfork patients, Bigfork Valley has yet to receive any payment for these services, despite appealing Humana's denials with over 50 phone calls, letters, emails and supporting documentation.