News: Humana files lawsuit against telehealth company, millions in alleged false claims

Humana has filed a lawsuit against the telehealth company QuivvyTech for allegedly defrauding Humana out of millions of dollars.

The suite alleges that QuivvyTech telemarketers cold-called Humana members, asking them questions about common ailments, Becker’s Hospital Review reported. QuivvyTech then wired the call recording to physicians who wrote expensive and unneeded cream prescriptions for Humana members they had never seen as a patient.

The prescriptions were then wired to pharmacies for fulfillment. According to Humana, QuivvyTech, the physicians, and the pharmacies were all complicit in the scheme. 

The lawsuit states that the medications would often be dispensed on multiple refills as well, and that patients’ general practitioners expressed concern about patients being prescribed the creams without their knowledge or input, Fierce Healthcare reported.

According to Humana, QuivvyTech also received Humana members’ contact information through “illegal means.” QuivvyTech would then tell plan members that they were working with Humana to obtain health status information, Becker’s Hospital Review reported.

Humana claims that in addition to the millions of dollars lost in false claims, the scheme also created strained relationships between the insurance company and its members.

The lawsuit includes breakdowns for wrongly submitted claims by certain physicians and pharmacies, according to Fierce Healthcare. One doctor cited submitted 1,600 claims (for which Humana paid over $1 million), and one pharmacy submitted 2,100 claims for one type of cream (for which Humana paid more than $2.5 million).

Editor’s note: To read Becker’s Hospital Review’s coverage of this story, click here. To read Fierce Healthcare’s coverage of this story, click here. To learn more about CDI’s involvement with telehealth record reviews, click here.