In 2014, the Centers for Medicare & Medicaid Services drafted a plan to prevent overbilling by Medicare Advantage health insurers, requiring them to identify overpayments and refund the government. However, they abandoned the plan in May 2014 due to industry pressure. This decision is at the center of a multibillion-dollar civil fraud case against UnitedHealth Group, accusing them of cheating Medicare out of over $2 billion by adding revenue through additional diagnoses while ignoring overcharges. The case highlights the industry’s tendency to exaggerate patient illnesses for higher payments and the lack of oversight by CMS in regulating Medicare Advantage plans.
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Feds killed plan to curb Medicare Advantage overbilling after industry opposition
