Judge throws out CMS 2014 rule, now how will CMS determine whether it has overpaid

On Friday, the U.S. District Court for the District of Columbia granted UnitedHealth’s motion for summary judgement and vacated CMS’s 2014 overpayment rule. According to the ruling, one of the issues is that the current way CMS calculates payment results in a false appearance of better health among Medicare Advantage enrollees compared to traditional Medicare participants, leading to systematic underpayments to MA insurers. This leads to the question of how CMS will amend the rule determine whether it has overpaid a Medicare Advantage (MA) insurer. Read article here…

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