Tag:Medicare Advantage
Profits Over Patients: The DOJ’s Fraud Investigation into UnitedHealth’s Medicare Practices
The Department of Justice (DOJ) has launched a civil fraud investigation into UnitedHealth’s Medicare billing practices, scrutinizing allegations that the company improperly inflated patient diagnoses to secure higher federal payments. While the investigation was publicly announced via the Wall Street Journal recently, it has been underway since 2024. This development follows the December 2024 death of UnitedHealth CEO Brian Thompson, which sparked renewed public discourse on the ethics of insurance companies. Many individuals came forward with stories of denied coverage for life-saving treatments, raising broader concerns about the practices of private insurers managing Medicare benefits.
D.C. District Court Vacates CMS Overpayment Rule for Medicare Advantage Organizations
On September 7, 2018, the United States District Court in the District of Columbia (“D.C. District Court”) vacated Medicare’s overpayment “report and return” rule as applied to Medicare Advantage Organizations (“MAOs”). The Patient Protection and Affordable Care Act (PPACA) created the requirement to report and return overpayments. The Centers of Medicare and Medicaid (CMS) issued rules to provide definitions that the PPACA did not define, create a procedure, payment options and timeframes. MAOs may no longer need to comply with CMS’ overpayment rule, but the PPACA remains intact. Providers who service Medicare beneficiaries will need to conduct the same analysis in order to comply with the PPACA “report and return” requirement.
CMS Issues Proposed Rule Addressing Multiple Fraud and Abuse Concerns
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 The Centers for Medicare and Medicaid Services (CMS) recently proposed a new rule in the Federal Register that addresses changes in Medicare payment policies. The proposed rule aims to inform providers of proper billing practices and prevent fraud and abuse. This post …
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Medicare Advantage Audits Reveal Alleged Rampant Upcoding
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 Last month, the Center for Public Integrity obtained over three-dozen new Medicare Advantage (MA) audits through a lawsuit brought under the Freedom of Information Act. The audits indicate that overcharging is still a pervasive problem in the MA Program because Medicare Advantage …
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