Health

Supreme Court Denies UnitedHealth Medicare Advantage Appeal

The Supreme Court declined to hear UnitedHealthcare’s protest against a federal ruling that makes Medicare Advantage insurers liable for claims under the False Claims Act when they fail to pay back overpayments, the judges announced Tuesday.

Thus, the decision of the Court of Appeal upholding this rule remains in force. Under federal law, Medicare Advantage insurers must repay certain overpayments within 60 days of receipt. Otherwise, they may be subject to civil liability and fines. The rule applies when insurers send diagnostic codes to Medicare and Medicaid service centers that are not documented on patient records.

A subsidiary of the UnitedHealth Group sued CMS in 2016, alleging that the overpayment rule treats private Medicare Advantage insurers differently from traditional Medicare, violating the “actuarial equivalence” standard between the two forms of coverage.

UnitedHealthcare will abide by the CMS rules, a company spokesperson wrote in an email. “We are proud of the efforts we continue to make to bring greater clarity to the rules governing the growing and successful Medicare Advantage program,” the spokesperson wrote.

CMS did not immediately respond to a request for an interview.

The overpayment rule, adopted in 2014, aims to curb upcoding and fraudulent billing. According to the Medicare Payments Advisory Panel, Medicare Advantage operators exaggerating patient conditions resulted in about $12 billion in overpayments in 2020.

UnitedHealthcare asked the Supreme Court to reconsider its case in February after the U.S. Court of Appeals for the District of Columbia Circuit overturned a lower court’s decision to strike down that rule last year.

The company’s mission has attracted the support of various Medicare Advantage stakeholders, including the AHIP trade group, technology company agilon health, and the US Chamber of Commerce.


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