{"id":9641,"date":"2023-09-07T08:48:08","date_gmt":"2023-09-07T08:48:08","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=9641"},"modified":"2023-09-07T08:48:08","modified_gmt":"2023-09-07T08:48:08","slug":"humana-files-lawsuit-against-u-s-government-over-medicare-clawback-rule","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/humana-files-lawsuit-against-u-s-government-over-medicare-clawback-rule\/","title":{"rendered":"Humana Files Lawsuit Against U.S. Government Over Medicare Clawback Rule"},"content":{"rendered":"

Health insurer Humana has filed a lawsuit against the U.S. government to block a Biden administration policy allowing Medicare to recover funds from insurers for overcharges. Humana claims the policy lacks justification and could have unpredictable consequences for Medicare Advantage plans. This rule aims to recoup payments for diagnoses not in patients’ medical records and could potentially recover up to $4.7 billion over a decade. The case was filed in the U.S. District Court in Texas, known for its history of challenging federal regulations and assigned to Judge Reed O’Connor, who previously ruled against parts of Obamacare.<\/p><\/blockquote>\n

Humana (HUM.N), to stop a policy put in place by the Biden administration, filed a lawsuit against the U.S. government on Friday. With the help of this program, Medicare can obtain billions of dollars from insurance providers for overbilling.<\/p>\n

The lawsuit, which was filed in federal court, contends that the Centers for Medicare and Medicaid Services (CMS) failed to provide adequate justification for its more stringent approach in assessing whether private Medicare Advantage plans for individuals aged 65 and older had been overcharged.<\/p>\n

Humana’s objection pertains to a rule unveiled on January 30th, allowing the government to recoup payments when audits reveal charges for medical diagnoses that are absent from patients’ medical records. The insurer argued that this rule, with retroactive application, was arbitrary and posed unpredictable consequences for both Medicare Advantage organizations and the millions of senior citizens relying on this program for their healthcare needs.<\/p>\n

Approximately half of the 65 million Medicare enrollees opt for Medicare Advantage plans. The Biden administration anticipates that this crackdown could help recover up to $4.7 billion over a decade.<\/p>\n

In response to the lawsuit, CMS, a branch of the U.S. Department of Health and Human Services, declined to comment on ongoing legal matters.<\/p>\n

Medicare Advantage plans differ from traditional Medicare as they are offered by private companies that are reimbursed by the government for healthcare services.<\/p>\n

Secretary of Health and Human Services Xavier Becerra described the rule as “long overdue” when announcing it. He cited federal watchdogs and external experts who had voiced concerns for years about Medicare’s failure to combat overbilling.<\/p>\n

The rule revolves around the “risk adjustment” system, which adjusts payments based on factors such as the expected medical expenses of healthier patients being lower. Humana argued that CMS had rejected the documentation standards required under this rule over a decade ago, and its sudden reversal was unjust to insurers that had relied on previous practices.<\/p>\n

Despite being headquartered in Louisville, Kentucky, Humana filed its lawsuit in the U.S. District Court for the Northern District of Texas. This court has shown sympathy towards certain challenges to federal regulations in recent years.<\/p>\n

The case has been assigned to U.S. District Judge Reed O’Connor, a Fort Worth judge who previously declared all or part of the Affordable Care Act (Obamacare) unconstitutional. The case is officially titled Humana Inc et al v Becerra et al, U.S. District Court, Northern District of Texas, No. 23-00909.<\/p>\n","protected":false},"excerpt":{"rendered":"

Health insurer Humana has filed a lawsuit against the U.S. government to block a Biden administration policy allowing Medicare to… Continue Reading <\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":9642,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[],"class_list":{"0":"post-9641","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-distilinfo-originals","8":"entry"},"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/9641"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=9641"}],"version-history":[{"count":1,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/9641\/revisions"}],"predecessor-version":[{"id":9643,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/9641\/revisions\/9643"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/9642"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=9641"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=9641"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=9641"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}