UnitedHealthcare Loses Medicare Overpayment Rule Challenge (1)

A rule requiring Medicare Advantage private insurers to repay overpayments was upheld by the D.C. Circuit on Friday, reversing a win for UnitedHealthcare Insurance Co. in a decision that could lead to more False Claims Act lawsuits.

The “actuarial equivalence” requirement—found in a different part of the Medicare law than the overpayment provision—doesn’t apply to the Centers for Medicare and Medicaid Service’s overpayment rule, the U.S. Court of Appeals for the D.C. Circuit said.

The requirement only directs the agency to reimburse MA plans at about the same rates as traditional Medicare providers, the court said. It doesn’t refer ...