Medicare Seeks $4.7 Billion From Insurers in Audit Rule (3)

The US Medicare agency will seek about $4.7 billion over 10 years in clawback payments from private insurers that manage its programs under a long-awaited rule finalized Monday, a blow to the industry that sets up a likely court fight.

The rule, which governs audits of Medicare Advantage insurers by the Centers for Medicare and Medicaid Services, is tougher than the industry had lobbied for. It finalized a 2018 proposal for auditing the private plans that administer programs for the agency, a move intended to recover excessive payments based on exaggerated claims of patient illness.

“Today we are taking some ...