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Health Insurer Fined $500,000 After Investigation Into Gouging HIV Patients

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Health Insurer Fined $500,000 After Investigation Into Gouging HIV Patients

Jessica Mason Pieklo

The Florida Office of Insurance Regulation announced the fine following an investigation into allegations that Humana's business practices discriminated against people living with HIV and AIDS.

Florida regulators fined health insurance company Humana $500,000 for failing to cooperate with investigators related to claims that the company discriminated against people living with HIV and AIDS.

The Florida Office of Insurance Regulation (FOIR) announced the fine following an investigation into allegations that Humana’s business practices discriminated against people living with HIV and AIDS. That investigation resulted in a consent order in which Humana agreed to “maintain procedures to ensure that it does not by effect or design treat those living with HIV/AIDS less favorably than any other condition.”

Section 1557 of the Affordable Care Act (ACA) prohibits discriminatory health insurance practices, such as those that discourage enrollment into health plans by people with significant health-care needs, including individuals living with HIV and AIDS.

The U.S. Department of Health and Human Services (HHS) last year issued guidance to health insurers nationwide informing them that such practices violate the ACA’s nondiscrimination provision. In proposed regulations implementing Section 1557, HHS made clear that insurance plan benefits cannot be designed to treat people with disabilities unfairly.

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Analysis conducted by the AIDS Institute on Florida’s 2016 qualified health plans found that coverage for nearly all hepatitis B and C drugs by several insurers were subject to high co-insurance levels. Humana places almost all hepatitis C drugs on tier 5 pricing, according to the analysis. This translates into patients paying about 40 or 50 percent of drug cost after the patient pays a $3,800 deductible.

Humana also faces possible federal regulatory action. In 2014, the AIDS Institute and the National Health Law Program filed a complaint with the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) charging four Florida health plans, including Humana, with unlawful discrimination against people living with HIV and AIDS.

The insurance companies placed all HIV medications, including generics, on the highest cost-sharing tier, according to the complaint. The organizations allege that such practices discourage people with HIV and AIDS from enrolling in the insurance plans, which is a violation of the ACA’s nondiscrimination provision.

The OCR has not yet ruled on the 2014 complaint.

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