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August 19, 2021

Federal Appeals Court Reinstates Overpayment Rule for Medicare Advantage Plans

In 2018, UnitedHealthcare challenged a CMS Overpayment Rule requiring that if an insurer learns a diagnosis submitted to CMS for payment lacks support in the beneficiary’s medical record the insurer must refund that payment within sixty days. The United States Court of Appeals for the District of Columbia Circuit reversed the 2018 district court decision that vacated Medicare's Overpayment Rule.