Government Healthcare Policy, Business and Technology

More Medicare Advantage upcoding could follow court ruling

Modern Healthcare: A federal judge's recent decision to vacate a 2014 CMS rule that UnitedHealthcare said resulted in underpayment for Medicare Advantage insurers leaves the federal government with fewer tools to combat upcoding practices that cost the taxpayer-funded Medicare program billions of dollars.

U.S. District Judge Rosemary Collyer last week vacated the 2014 overpayment rule, which required Medicare Advantage plans to return overpayments to the government within 60 days of identifying them or they would be considered in violation of the False Claims Act and potentially subject to civil lawsuits, damages and penalties. Overpayments include diagnostic codes sent to the CMS for payment that are not documented in a patient's medical chart.

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