The Humana SettlementOn September 27, 2006 counsel for approximately 900,000 physicians and Humana , Inc. and Humana Health Plan, Inc. ("Humana") announced that they had received a final order settling a national class action lawsuit in federal court for the Southern District of Florida before U.S. District Judge Federico Moreno as well as multiple state court actions filed against the company. Humana is the fifth national health plan named as a defendant in the Managed Care Litigation in Florida to settle with physicians. The agreement includes both a monetary settlement and substantial commitments by Humana to institute a significant number of business practice changes that will benefit physicians.
This agreement includes industry-leading improvements to physician-related business practices. The cornerstone of these business practices is Humana's agreement to apply generally accepted medical standards and specific claims guidelines. Additionally, Humana has committed to increase transparency in paying claims and has agreed to an enforcement mechanism to help ensure compliance with the terms of the settlement. The agreement will also streamline communication between physicians and Humana, reduce administrative complexity in the claims payment system and help to improve the quality of the health care system in general.
The establishment of a Physicians’ Advisory Committee (PAC) of practicing physicians was one initiative contained in an agreement between Humana and representatives of thousands of physicians that settled a national class-action lawsuit. View the list of members of the Humana PAC.
Expiration date for this settlement agreement is 10/19/2009. Humana Compliance Dispute InformationCritical to the success of this settlement is the enforcement process, which will be facilitated by Carol Scheele, Associate General Counsel at the North Carolina Medical Society. In her role as the Compliance Dispute Facilitator, Ms. Scheele will oversee the compliance dispute resolution mechanism that is designed to address physician complaints regarding Humana's compliance with the terms of the settlement agreement.
The compliance dispute process is triggered by filing a brief dispute form describing how Humana has violated the terms of the settlement agreement. Documentation which illustrates the violation should be included with the form. Filing a compliance dispute involves no cost to physicians or their practices. For further information about the compliance dispute process or a copy of the dispute form, click on the appropriate links below. Information about the SettlementHumana Settlement AgreementHumana Settlement ExhibitsSignatory Medical Societies - Original Signatory Societies
- Additional Signatory Societies
- Joinder Form
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