Community Champion ⭐⭐⭐

United Healthcare Cleared of Wrong-Doing in Risk Score Overpayments

Forum|Forum|1 year ago
March 6, 2025
2 replies
948 views

I think the Center for Medicare and Medicaid Services should cut their losses on this one - If they have NOT won the case by now maybe they should stop wasting money with continuing it. Perhaps they should just stick to making the instructions for assessing higher risk patients clearer to all the insurers that participate in Medicare Advantage plans.

Continuing the case over and over when several ruling have already been made to vindicate the insurer is WASTEFUL spending on the part of the government (CMS).

KHN 03/04/2025 - UnitedHealth Wins Ruling Over $2B in Alleged Medicare Advantage Overpayments

from the link

The Justice Department’s years-long court battle to force UnitedHealth Group to return billions of dollars in alleged Medicare Advantage overpayments hit a major setback Monday when a special master ruled the government had failed to prove its case.

In finding for UnitedHealth, Special Master Suzanne Segal found that the DOJ had not presented evidence to support its claim that the giant health insurer exaggerated how sick patients were to illegally pocket more than $2 billion in overpayments.

SummerOnTheWay1

Community Champion ⭐⭐⭐

[Thursday 3/6/25] @GailL1 , maybe they want to make an EXAMPLE of what will happen IF other insurers try the same thing. Sad they are getting away with this.

Oh well!!!

Take care,

Nicole 👵

[*** @GailL1 wrote:
I think the Center for Medicare and Medicaid Services should cut their losses on this one - If they have NOT won the case by now maybe they should stop wasting money with continuing it. Perhaps they should just stick to making the instructions for assessing higher risk patients clearer to all the insurers that participate in Medicare Advantage plans.

Continuing the case over and over when several ruling have already been made to vindicate the insurer is WASTEFUL spending on the part of the government (CMS).

KHN 03/04/2025 - UnitedHealth Wins Ruling Over $2B in Alleged Medicare Advantage Overpayments

from the link
The Justice Department’s years-long court battle to force UnitedHealth Group to return billions of dollars in alleged Medicare Advantage overpayments hit a major setback Monday when a special master ruled the government had failed to prove its case.

In finding for UnitedHealth, Special Master Suzanne Segal found that the DOJ had not presented evidence to support its claim that the giant health insurer exaggerated how sick patients were to illegally pocket more than $2 billion in overpayments. ***]

GailL1Author

Community Champion ⭐⭐⭐

@SummerOnTheWay1

That's the thing, they all did it - but few have had to pay any money back because the courts are fining what they did as acceptable - personally, I think so too.

From the link:

“A mere possibility of an overpayment is not enough for the government to carry its burden,” Segal wrote in an initial ruling. She recommended that UnitedHealth’s motion to dismiss the case be granted. The recommendation, which is to be presented to the federal judge handling the case, can be appealed within two weeks.

. . . . Medicare pays Advantage health plans higher rates to cover sicker patients but requires that their conditions be properly documented in medical records.

Segal noted CMS audits of UnitedHealth’s Medicare Advantage plans had found that about 89% of billing codes were supported by patient medical records. The audit findings “undercut” the government’s claim that the company engaged in widespread overbilling.

“This litigation has been pending for more than a decade,” she wrote, “and the government has had ample opportunity to develop evidence in support of its theories. It has not.”

IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna

Sign up

Login with SSO

Login to the community

Login with SSO