HHS files appeal to reinstate controversial MA overpayment rule

The Department of Health and Human Services (HHS) has filed an appeal to reinstate a key rule that handles overpayments to Medicare Advantage (MA) plans, arguing a lower court's ruling was based on a flawed premise.
The appeal, filed Thursday in the federal Court of Appeals for the District of Columbia Circuit, could decide how much money MA plans, an increasingly lucrative market for insurers, will have to give back to Medicare for diagnosis errors. HHS argues that an earlier ruling striking down the plan misunderstood how Medicare audits MA plans.
The appeal is the latest salvo in a legal fight with insurers over a 2014 rule proposed by the Centers for Medicare & Medicaid Services (CMS).
CMS audits a sample of any MA plan’s claims to determine an error rate, then extrapolates that error rate across the entire plan.