In 2014, CMS drafted a rule to prevent overcharging by Medicare Advantage insurers, requiring them to identify and refund overpayments to the government. However, the rule was dropped in May 2014 due to industry pressure. This decision is now at the center of a DOJ civil fraud case against UnitedHealth Group, accusing them of cheating Medicare out of $2 billion. Despite denials of wrongdoing, the case involves allegations of inflated payments based on chart reviews. The case highlights the contentious relationship between CMS and private health plans, as well as the potential for abuse in the Medicare Advantage system.
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Feds Killed Plan To Curb Medicare Advantage Overbilling After Industry Opposition
