Humana Inc

Humana has a pattern of False Claims Act settlements reflecting systemic issues in its Medicare billing practices. In August 2024, Humana agreed to pay $90 million to the federal government — the largest False Claims Act settlement related to Medicare Part D prescription drug program fraud — to resolve whistleblower allegations that Humana submitted fraudulent bids to CMS for Medicare Part D contracts from 2011 through 2017. The DOJ alleged that Humana kept two sets of books: one set of actuarial projections for bids submitted to the government, and a separate internal set reflecting actual anticipated costs used for all other business dealings including budgeting.

In a separate case, Roche and Humana paid $12.5 million to settle the government's claims of kickback fraud — the first False Claims Act settlement arising from a Medicare Advantage Organization accepting a kickback from a pharmaceutical company. In February 2025, the DOJ filed a complaint against Humana and two other national health insurers alleging unlawful kickbacks and discrimination against disabled Americans in connection with Medicare Advantage marketing practices. The recurring pattern spans fraudulent bidding, pharmaceutical kickbacks, and discriminatory enrollment practices.