The Supreme Court docket declined to listen to UnitedHealthcare’s problem to a federal regulation that can make Medicare Gain insurers liable for False Claims Act lawsuits when they fall short to return overpayments, justices introduced Tuesday.
As these types of, an appeals court docket ruling that upheld the rule remains in force. Under federal legislation, Medicare Advantage carriers need to return specific overpayments inside of 60 days of receipt. If they do not, they might be issue to civil damages and penalties. The rule applies to circumstances in which insurers mail diagnostic codes to the Facilities for Medicare and Medicaid Providers that are not documented on patients’ medical charts.
The UnitedHealth Group subsidiary sued the CMS in 2016, alleging that the overpayment rule treats private Medicare Edge insurers otherwise than traditional Medicare, which violates the “actuarial equivalence” regular between the two kinds of coverage.
UnitedHealthcare will comply with CMS rules, a firm spokesperson wrote in an electronic mail. “We are happy of the endeavours we carry on to make to convey increased clarity to the procedures governing the escalating and successful Medicare Gain system,” the spokesperson wrote.
CMS failed to quickly respond to an job interview request.
The overpayment rule, enacted in 2014, aims to control upcoding and fraudulent billing. Medicare Gain carriers exaggerating client disorders led about $12 billion in excess payments in 2020, according to the Medicare Payment Advisory Fee.
UnitedHealthcare questioned the Supreme Courtroom to reconsider its circumstance in February, soon after the U.S. Courtroom of Appeals for the District of Columbia reversed a lower court’s final decision to vacate the rule past yr.
The company’s challenge captivated the assistance of a wide range of Medicare Edge stakeholders, together with the trade group AHIP, the technology company agilon overall health and the U.S. Chamber of Commerce.