America's Physician Groups and America's Health Insurance Plans are among the organizations throwing support behind UnitedHealthcare's effort to have the Supreme Court reverse a federal appellate court's decision regarding Medicare overpayments, Law360 reported March 23.
Five things to know:
1. The U.S. Court of Appeals for the District of Columbia in August 2021 reversed a 2018 decision that vacated Medicare's overpayment rule, which requires insurers to refund payment to CMS within 60 days if it learns a diagnosis lacks medical record support.
2. UnitedHealthcare had argued in the appellate court that the overpayment rule was subject to "actuarial equivalence." The court ruled that actuarial equivalence does not apply to the overpayment rule and there was no legal basis for UnitedHealthcare's claim.
3. UnitedHealthcare petitioned the ruling to the Supreme Court in February, according to Law360.
4. America's Health Insurance Plans said in its amicus brief the overpayment rule will impose different coding burdens and obligations on healthcare providers depending on whether a patient is a Medicare Advantage enrollee or an original Medicare patient.
"And by altering the actuarial assumptions underlying Medicare Advantage, it will require [Medicare Advantage Organizations] to modify their annual bids, including by increasing the costs or reducing the benefits and provider networks that have attracted tens of millions of Medicare beneficiaries to Medicare Advantage plans," the group said.
5. America's Physician Groups said the court's ruling is also harmful to providers, according to its amicus brief. The organization said the overpayment rule will not only discourage risk-sharing arrangements, but will also undermine the equitable distribution of services by creating disincentives for plans and providers to treat the least healthy patients.