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Humana to back curbs to Medicare Advantage billing practices, WSJ reports
- 6/5/2025
(Reuters) -Humana has told congressional staffers that it will support moves that would curtail billing practices worth billions in extra payments to the industry, the Wall Street Journal reported, citing staffers and a document viewed by it.
The company is willing to back new limits on lucrative payments insurers can gain from diagnoses recorded by nurse practitioners who visit millions of enrollees in their homes, according to a one-page policy overview shared with the staffers, the WSJ reported on Thursday.
Humana did not immediately respond to a Reuters request for comment.
Nearly half of the 65 million people covered by Medicare, the U.S. program for people aged 65 and older or with disabilities, are enrolled in Medicare Advantage plans run by private insurers.
Insurers are paid a set rate for each patient, but can be paid more for patients with multiple health conditions.
Last fall, staff working for Senators Mike Crapo and Ron Wyden, the leaders of the Senate Finance Committee, contacted Medicare Advantage insurers for suggestions on legislative steps that would address the potential misuse of home visits described in Journal articles, the newspaper reported citing people familiar with the matter.
The Journal reported in February that the U.S. Department of Justice was examining UnitedHealth's practices for recording diagnoses that trigger extra payments to its Medicare Advantage plans.
The healthcare conglomerate had then said it was unaware of any new probe.
The WSJ has run a series of stories over the last several months detailing how UnitedHealth profited from using Medicare billing rules to its favor.
(Reporting by Sriparna Roy in Bengaluru; Editing by Shailesh Kuber and Shilpi Majumdar)