Medicare Advantage Overpayment Rule Faces Opposition from UnitedHealth Group

UnitedHealth Group is fighting the new Medicare Advantage Overpayment rule with a suit against the Secretary of Health and Human Services.  Filed in the U.S. District Court for the District of Columbia on January 29th, 2015, UnitedHealth Group claims the rulegavel does not comply with the previous legislation of the Medicare Act.

The Medicare Act states that Medicare Advantage and standard fee-for-service Medicare participants health status should be assessed similarly.  The new Medicare Advantage overpayment rule is requiring insurance companies to refund payments made to them for conditions that cannot be further substantiated by more specific documentation in the patient’s medical charts.

UnitedHealth Group points out that fee-for-service Medicare participants are not required to produce the additional documentation in order for their claims to be paid, therefore violating the Medicare Act.  They also state that if companies are forced to repay for this reason, it will result in huge underpayments for Medicare Advantage plans due to the violation of “actuarial equivalence”.

Posted in Affordable Care Act, Industry News, Legislative News, Medicare Advantage/Part D Prescription