Rule would have required Medicare Advantage health insurers to identify overpayments and refund them to government.
A decade ago, federal officials drafted a plan to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars — only to abruptly back off amid an 'uproar' from the industry, newly released court filings show. The Centers for Medicare & Medicaid Services published the draft regulation in January 2014.
DOJ alleges Medicare paid the insurer more than $7.2 billion from 2009 through 2016 solely based on chart reviews; the company would have received $2.1 billion less if it had deleted unsupported billing codes, the government says. The government argues that UnitedHealth Group knew that many conditions it had billed for were not supported by medical records but chose to pocket the overpayments.
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