Feds Kill Plan to Curb Medicare Advantage Overbilling After Industry Opposition

In 2014, the Centers for Medicare & Medicaid Services (CMS) proposed a regulation aimed at curbing overbilling by Medicare Advantage insurers, which would have required these plans to identify and refund overpayments to the government. However, the proposal was withdrawn after significant pushback from the industry, with CMS officials citing pressure from stakeholders. This decision is now central to a civil fraud case against UnitedHealth Group, which is accused of defrauding Medicare of over $2 billion by improperly billing for additional diagnoses while ignoring unsupported charges. The Justice Department claims that UnitedHealth's practices led to inflated payments, as the company allegedly failed to delete invalid billing codes. UnitedHealth denies any wrongdoing, arguing that it should not be penalized for a rule that was never implemented. The case highlights ongoing concerns about the oversight of Medicare Advantage plans, which have seen rapid growth and are often criticized for exaggerating patient conditions to secure higher payments. Experts have noted that the CMS's reluctance to enforce stricter regulations reflects a broader issue of inadequate oversight in the face of powerful health insurers. The situation raises alarms about the potential misuse of taxpayer funds in the Medicare system.

- CMS proposed a regulation in 2014 to curb Medicare Advantage overbilling but withdrew it due to industry pressure.

- UnitedHealth Group faces allegations of defrauding Medicare of over $2 billion through improper billing practices.

- The case underscores ongoing concerns about the oversight of Medicare Advantage plans and their financial practices.

- Experts criticize CMS for lacking the enforcement needed to protect taxpayer funds from potential misuse.

- Medicare Advantage plans have grown significantly, now enrolling over 33 million members, raising scrutiny over their billing practices.