News & Perspectives

District of Columbia Court of Appeals Panel Requires Medicare Advantage Plans to Return Medicare Overpayments

31. August 2021 Sam Fish Health

On Friday, August 13, 2021, a panel of the D.C. Court of Appeals held that Medicare Advantage private insurers must return potentially billions of dollars in overpayments they receive based on incorrect diagnoses. The case is UnitedHealthcare Inc., Co. v. Becerra, D.C. Cir., No. 18-5326, 8/13/21.

The Court determined that the “actuarial equivalence” requirement found in a different part of the Medicare law than the overpayment provision does not apply to the Centers for Medicare & Medicaid Services’ (CMS) overpayment rule. 

This decision, which overruled a lower court decision could lead to more False Claims Act lawsuits.