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UnitedHealthcare Wins Medicare Managed Care Overpayment Suit

Sept. 7, 2018, 8:49 PM

UnitedHealthcare and affiliates that serve over 3.5 million Medicare managed care enrollees convinced a federal trial court to overturn a 2014 rule that established how the federal government determined overpayments these insurers had to repay.

A federal trial court said the rule went too far in classifying any inadequately documented treatment code as an overpayment. The rule was flawed because it required insurers offering Medicare managed care plans to conduct audits, and fix any coding errors, despite the fact that the Medicare agency wasn’t conducting similar audits of traditional Medicare payments.

The Sept. 7 decision by Judge Rosemary Collyer of ...