U.S. District Adjudicator Rosemary Collyer aftermost anniversary alone the 2014 overpayment rule, which appropriate Medicare Advantage affairs to acknowledgment overpayments to the government aural 60 canicule of anecdotic them or they would be advised in abuse of the Apocryphal Claims Act and potentially answerable to civilian lawsuits, amercement and penalties. Overpayments accommodate analytic codes beatific to the CMS for acquittal that are not authentic in a patient’s medical chart.
Whistleblower lawsuits accept challenged Advantage insurers, including UnitedHealthcare, for combing accommodating medical archive to acquisition and address all accessible diagnoses to abide for added Medicare payments—a convenance accepted as upcoding—but not deleting codes they knew were inaccurate.
Healthcare experts said that the overpayment aphorism was meant to advice barrier upcoding and counterfeit billing; abandonment it paves the way for added of the same. It additionally gives insurers added accoutrement to avert themselves adjoin Apocryphal Claims Act liability. Already, UnitedHealth has filed a annual in a awaiting Medicare Advantage bigmouth clothing answer that Adjudicator Collyer’s accommodation could affect the whistleblower’s claims.
The cardinal “is absolutely adverse to taxpayers and to the Medicare affairs in that all the levers in
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