Prognosis
Medicare Wants to Claw Back $4.7 Billion From Private Health Insurers
- Companies don’t get leniency sought for diagnostic errors
- Blow to Humana, UnitedHealth, other firms sets stage for suits
Two people inside a Medicare Services office in New York City.
Photographer: Spencer Platt/Getty ImagesThis article is for subscribers only.
The US Medicare agency will seek about $4.7 billion over 10 years in clawback payments from private insurers that manage its programs under a long-awaited rule finalized Monday, a blow to the industry that sets up a likely court fight.
The rule, which governs audits of Medicare Advantage insurers by the Centers for Medicare and Medicaid Services, is tougher than the industry had lobbied for. It finalized a 2018 proposal for auditing the private plans that administer programs for the agency, a move intended to recover excessive payments based on exaggerated claims of patient illness.