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Justice Department probing Humana’s Medicare risk adjustment
Modern Healthcare

The U.S. Justice Department has asked health insurer Humana for information related to its Medicare Advantage risk-adjustment practices, building off a whistle-blower case from several years ago, Humana said in a regulatory filing late Wednesday.

The disclosure states that federal officials “recently” sent a request to Louisville, Ky.-based Humana asking for more information about how it submits and manages risk-adjustment data for Medicare Advantage beneficiaries. The CMS pays fixed monthly amounts to Medicare Advantage insurers like Humana partially based on risk scores, which indicate how sick members are. Higher risk scores correlate to sicker patients and thus lead to higher payments to insurers.