UnitedHealthcare told the Supreme Court on May 31 that the U.S. Court of Appeals for the District of Columbia made a mistake last August when it ruled against the payer's legal challenge to a Medicare Advantage overpayment rule.
The rule requires a payer to refund payments to CMS within 60 days if it learns a diagnosis lacks medical record support. In a reply brief, UnitedHealthcare argued against the federal government's defense of the rule, saying it "offers no defense of the blatant statutory error at the heart of the D.C. Circuit's decision."
The argument stems from whether CMS must ensure there is actuarial equivalence between Medicare Advantage payments and traditional fee-for-service Medicare payments.
In the court documents, UnitedHealthcare argues the D.C. Appeals court made a "blatant" error when it found that "actuarial equivalence does not apply to the overpayment rule or the statutory overpayment refund obligation under which it was promulgated."
The payer also argued that the federal argument has failed to provide a valid defense of the rule and "largely ignores the amici from across the healthcare industry" who say Medicare Advantage will be negatively affected by the appeals court's ruling.
In March, America's Physician Groups and America's Health Insurance Plans threw their support behind UnitedHealthcare's effort to overturn the appeals court's decision, arguing the rule will impose coding burdens and obligations and disincentivize risk-sharing arrangements.