CMS appeals ruling on Medicare Advantage overpayments: 4 things to know

On Nov. 6, CMS filed an appeal to a September judgment that overturned a 2014 overpayment rule for Medicare Advantage plans.

Here are four things to know:

1. The 2014 overpayment rule concerns an ACA requirement that Medicare Advantage plans return any overpayments to the federal government within 60 days after identification.

2. In a Sept. 7 opinion filed in the U.S. District Court for the District of Columbia, Judge Rosemary Collyer vacated the rule. In her opinion, she said requiring the risk-adjustment data submitted to CMS to calculate payments be 100 percent accurate violates the statutory mandate of "actuarial equivalence" between payments for healthcare coverage under Medicare Advantage plans and traditional Medicare.

3. The rule was initially challenged in a lawsuit brought by UnitedHealth Group and its subsidiaries in January 2016.

4. Medicare Advantage plans have come under greater scrutiny from CMS recently. In late October, the agency said it is poised to claw back $1 billion from Medicare Advantage organizations by 2020 through widespread audits, according to a proposed rule.

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