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Home > BizTimes Daily > Archives > September 10, 2008
State reaches Medicare compliance settlement with Humana
Published September 10, 2008 - BizTimes Daily
Wisconsin Insurance Commissioner Sean Dilweg today announced that the state has assessed a forfeiture of $750,000 as part of a regulatory settlement agreement between the Office of the Commissioner of Insurance (OCI) and Humana Insurance Company.
"With this settlement, we protect our senior citizens by addressing issues with marketing of Medicare Advantage and Medicare Part D products," Dilweg said. "The settlement also resolves long-standing issues with company claim adjudication, customer service and underwriting practices."
Dilweg said the regulatory settlement is based in part on a market conduct examination that was conducted as a follow-up to a previous examination of Humana, and in part due to concerns over Medicare Advantage and Medicare Part D marketing practices. The examination report documented multiple problems involving compliance with previous recommendations from the OCI, Dilweg said. The report also documented significant issues with compliance procedures and oversight of Medicare Advantage and Medicare Part D marketing activities, he said.
Humana had notified the OCI that it had developed procedures to prevent agents who were not properly certified and licensed from receiving commissions for Medicare Advantage and Medicare Part D products. However, the examination determined that Humana continued to accept applications and pay commissions, Dilweg said. The company was one of the largest Wisconsin writers of Medicare Advantage and Part D plans during the review period.
Humana denied the allegations in the examination report and any violation of law, but agreed to the settlement.
Deputy Insurance Commissioner Kim Shaul said Humana has agreed to correct the issues. "We appreciate their cooperation in resolving the problems we have identified," Shaul said.
