US Supreme Court rejects UnitedHealth Group’s dispute over Medicare overpayments by Reuters


© Reuters. FILE PHOTO: The UnitedHealth Group headquarters building can be seen in Minnetonka, Minnesota, USA in this photo taken in 2019. UnitedHealth Group / Distribution via REUTERS / File photo

By Brendan Pearson

(Reuters) – The U.S. Supreme Court on Tuesday declined to hear a challenge from UnitedHealth Group Inc (NYSE 🙂 against a government rule requiring private insurers who administer federally funded Medicare plans to repay potentially billions of dollars in overpayments. incorrect diagnoses.

Rejecting the Minnesonka-based insurer Minnesota’s appeal, the judges upheld a lower court’s decision resuming the rule after a federal judge overturned it.

UnitedHealth did not respond immediately to a request for comment.

The 2014 rule applies to so-called Medicare Advantage insurance plans, which are funded by the US Department of Health and Human Services (HHS) but administered by private insurers such as UnitedHealth. HHS pays Medicare Advantage plans a principal amount per beneficiary, adjusted according to diagnostic codes that reflect the individual risk factors of each beneficiary.

According to the rule, if an insurer of Medicare Advantage learns that he has received a payment based on an unconfirmed diagnosis, he must return this payment within 60 days.

According to a 2016 federal audit, in the same year the government paid about $ 16.2 billion based on unconfirmed diagnoses, almost 10% of the total amount paid to Medicare Advantage insurers.

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