The nuanced legal battle over Medicare Advantage overpayments rages on.
The Centers for Medicare & Medicaid Services (CMS) has filed an appeal of September’s landmark legal decision that struck down a 2014 rule requiring Medicare Advantage insurers to return overpayments to the federal government.
The agency filed its appeal earlier this month. It was docketed with the U.S. Court of Appeals for the District of Columbia Circuit on Wednesday.
UnitedHealth challenged the overpayment rule in 2016 and scored a significant victory two months ago when U.S. District Judge Rosemary Collyer sided with the insurer, ruling that the CMS rule requiring MA insurers to report and return overpayments based on an analysis of its members’ health states was “wholly inconsistent” with Medicare fee-for-service requirements.
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Collyer granted UnitedHealth’s motion to scrap the rule entirely, noting that the government failed to adequately explain its departure from prior policies. Dozens of UnitedHealth insurers successfully argued that the rule—which classifies each incorrect diagnostic code as an overpayment—was an added layer of scrutiny above and beyond the traditional Medicare program.
UnitedHealth is currently locked in a heated legal battle with the government over whistleblower claims the insurer ignored overbilling errors and inflated risk scores for MA members in order to obtain higher reimbursement from CMS.
Federal prosecutors have already abandoned one of the two cases against the insurer after a federal judge dismissed the case. But much of the ongoing litigation is predicated on the 2014 rule that required insurers to report and return overpayments.