HMO Fraud Held Accountable
October 17, 2009 by Bob Christensen
In 1995, Mark and Barbara Chipps received an unsigned letter from their insurance company, Humana Health Insurance Co. of Florida, informing them that their four-year-old daughter, Caitlyn, who was born with cerebral palsy, would be terminated from a special program for terribly and chronically ill patients called medical case management.
There was no medical diagnosis supporting Humana’s decision, and it clearly violated the terms of the family’s insurance agreement. When the Chipps’ appealed to the company, they were told that Caitlyn’s speech, occupational and physical therapies would be terminated as well.
The Chipps’ exhausted their resources in an attempt to continue Caitlyn’s care. Caitlyn regressed and began walking into walls. Finally the Chipps’ turned to the civil justice system for help.
The ensuing litigation uncovered widespread fraud at Humana. The insurance company had unlawfully denied coverage to more than 100 catastrophically ill and injured children in Florida in an effort to boost its bottom line. In one instance, Humana had even sent a letter to a child – not the parent – who had been in a coma for 14 years advising him that he had improved to such an extent that he no longer needed the medical case management. The insurance company was also paying bonuses to physicians and nurses based on the number of medical claims denied each month. The jury found that Humana intentionally disregarded its insureds’ health and safety, and awarded Caitlyn and her family restitution equal to the $78.5 million Humana thought it could save by cutting children’s coverage. The insurance company fought the award, and the Chipps’ later settled for $2.2 million. More importantly, Caitlyn was put back on the medical case management, and Humana’s behavior was exposed for all the world to see.
As reported by AAJ
sources: Stephen Van Drake, “Attorney Battles Humana, Again,” South Florida Business Journal, June 28, 2002; “5-Year Old Cerebral Palsy Victim Wins Landmark Trial Against Humana,” Ricci- Leopold Law Firm, http://www.riccilaw.com/CM/Articles/Articles69.asp; Chipps v. Humana Health Insurance Co. of Florida, Inc., No. CL 96-00423 AE (Fla., Palm Beach County Cir. Ct. Jan. 4, 2000.
