Humana is suing QuivvyTech, saying the telemedicine company caused millions of dollars in damages through an elaborate scheme that preyed upon its members.
QuivvyTech telemarketers cold-called Humana members, many of them living in Florida, and tricked them into talking about common ailments, the lawsuit said. They then wired the information, including recordings of the calls, to QuivvyTech physicians, who electronically prescribed high-cost topical creams to the members without ever having met or spoken to them, according to Humana.
The alleged fraudulent prescriptions were then wired to co-conspirator pharmacies, which billed, dispensed and/or shipped the medications to the members, often numerous times through automatic refills, Humana said.
The coconspirator pharmacies are not named as defendants in the complaint due to contractual arbitration provisions between them and Humana Pharmacy Solutions.
Humana said it was billed millions of dollars for these fraudulent prescription claims, which Humana paid through wire transfers while unaware of the scheme. In turn, Humana members often were left confused, irate and in the possession of unwanted expensive creams.
In addition, QuivvyTech defendants cold-called, or engaged others to cold-call, members of plans sponsored or administrated by Humana based on leads obtained through illegal means, the lawsuit said. The callers would then trick Humana members into providing information regarding their health to the QuivvyTech defendants by representing that they were working with Humana, the members' physicians or their pharmacies and/or providing Humana members with their confidential information obtained from improper sources, it said.
QuivvyTech paid physician defendants for a "visit" with these Humana members that never occurred and in some cases, Quivvy Tech Corp. even billed Humana members for this "visit," according to the lawsuit.
Multiple physician defendants prescribed medications for the same Humana member based on the same information improperly obtained from a telemarketing call, the lawsuit said.
Physician defendants did not contact the Humana members' physicians to ensure the prescribed medications were consistent with the Humana members' current treatment plans. Indeed, Humana physicians expressed concerns about their patients receiving these medications without their knowledge, the lawsuit said.
QuivvyTech defendants funneled these illicit prescriptions directly or indirectly to coconspirator pharmacies across the nation who paid to participate in the telemedicine scheme, Humana said. Coconspirator pharmacies billed Humana for the illegal prescriptions, which the insurer paid.
WHAT'S THE IMPACT?
Humana said members were unfamiliar with the coconspirator pharmacies until unwanted prescription creams mysteriously arrived at their door or they learned that coconspirator pharmacies billed Humana for prescription drugs that they did not receive.
Some of the defendants intentionally violated federal and Florida criminal and civil laws by luring unwitting Humana members into providing protected health information, the lawsuit said.
As a result, Humana has been damaged by the payment of millions of dollars in pharmaceutical claims. They are seeking treble damages, plus interest and fees.
THE LARGER TREND
Long-term, the conduct could cause significant reputational harm and a loss of goodwill and trust between Humana and its members, the lawsuit said.
Humana wants the court to order a preliminary and permanent injunction to enjoin and restrain the QuivvyTech defendants from targeting and soliciting Humana members.
Humana is requesting a jury trial.
The lawsuit was filed August 20 in U.S. District Court Southern District of Florida.
QuivvyTech could not be immediately reached for comment.
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