Humana has been misleading investors about the value of its Medicare Advantage primary care clinics, reports Casey Ross and Tara Bannow for StatNews. Humana was investing almost $2 billion to expand these clinics. It did not want its investors to know that the clinics were providing fewer primary care visits than other clinics, undermining enrollees’ health outcomes, and sending them to the hospital and emergency room more frequently.
If you’re in a Medicare Advantage plan, be it one run by Humana or another big insurer, beware. What you think are your benefits are likely very different from what you’ll get if you need costly care. Now’s a good time to take a hard look because you are in the Medicare Advantage open enrollment period through March 31, which allows you to disenroll and switch to traditional Medicare or another Medicare Advantage plan effective on the first day of the month following your disenrollment.
Here’s Humana’s story: Humana had internal research showing that its clinics delivered higher hospitalization and ER rates than other clinics that Humana did not own. Had Humana shared this research with investors. It would have led to a lower stock price. Eighty percent of Humana’s revenue comes from Medicare Advantage.
That said, the clinics allow Humana to ensure that its Medicare Advantage primary care providers are “coding” patients and meeting Medicare quality standards in ways that increase Humana’s Medicare revenues. (Medicare pays Medicare Advantage insurers more for enrollees with more diagnosis codes on the theory that they will use more care.) One study found that Humana’s clinics were able to add enough extra codes to patient records to generate 50 percent more income from Medicare, even though its enrollees did not receive more care.
STAT learned from nine former Humana employees that Humana manipulates its research questions and data. The company does not want the public to see that Traditional Medicare delivers better health outcomes than Medicare Advantage. A prior STAT investigation found that UnitedHealth has engaged in similar practices, in a number of ways, including through methodological flaws in its research.
No one should be deceived. Traditional Medicare covers the care people need from providers they know and trust anywhere in the US. Unlike Medicare Advantage, in Traditional Medicare, people have access to top specialists and, overall, better health outcomes when they develop complex conditions. No one is second-guessing a treating physician and inappropriately delaying or denying needed care, as insurers too often do in Medicare Advantage.
Here’s more from Just Care:
- 2026: Five things to think about when choosing between Traditional Medicare and a Medicare Advantage plan
- Medicare Advantage: Denials and more denials, some deadly
- Medicare Advantage delivers unreliable coverage
- Insurers dump 1.5 million + Medicare Advantage enrollees
- Medicare Advantage networks can be narrow and harmful
