Humana has filed suit against Florida-based telehealth company QuivvyTech, saying it was defrauded out of millions of dollars.
According to the suit, filed in Southern Florida district court, QuivvyTech telemarketers would cold-call Humana members and ask them questions about common ailments. They would then wire that information to physicians who were in the scheme to secure prescriptions for pricey, unneeded creams.
The physicians would prescribe these creams without ever speaking to the patient directly, according to the lawsuit. The prescriptions would then be wired to pharmacies that were also active participants in the scheme to be dispensed to members, Humana said.
The medications would often be dispensed on multiple refills as well, according to the lawsuit.
RELATED: Humana sues Trump administration over ACA cost-sharing reduction payments
The members' regular physicians expressed concern about their patients obtaining the creams without their knowledge or input, according to the lawsuit.
In addition to the millions lost in false claims, Humana alleges in the lawsuit that the scheme caused significant harm to its relationship with affected members.
"Humana relies on its members’ trust to facilitate what can be one of the most sensitive business relationships a person enters into: one related to healthcare," the insurer said. "By misrepresenting themselves as Humana and/or engaging in tactics where Humana members believe they are Humana in furtherance of their illegal conduct, the QuivvyTech defendants are eroding this trust and goodwill that Humana has garnered with its members."
The lawsuit includes breakdowns for the claims it alleges were wrongly submitted by a number of physicians and pharmacies.
One doctor, for instance, submitted 1,600 claims through the scheme to which Humana paid out more than $1.1 million, the insurer alleges in the suit.
A New York pharmacy submitted 2,100 claims for one type of cream, for which Humana paid more than $2.5 million, the insurer alleges.
Humana said in the lawsuit that it expects further defendants to surface during discovery for the case. QuivvyTech declined to comment on the lawsuit, saying it could not discuss pending litigation.