Highmark, Inc., a Pennsylvania insurance company, has entered into an agreement with the federal government to resolve allegations that it underpaid amounts due for care of certain Medicare beneficiaries. Medicare is a secondary payer for its beneficiaries who have other coverage under employer group health plans. The group health plans, in these cases ones administered by Highmark, are responsible for primary payment.
According to the terms of the settlement, announced June 19, 2006 by the U.S. Attorney’s Office for the Eastern District of Pennsylvania, Highmark will pay $2.5 million and enter into a “model Medicare secondary payer” program.
The suit originated in a qui tam, complaint filed by a former Highmark employee who will receive $818,632 as her relator’s share.