A draft regulation in 2014 aimed to prevent Medicare Advantage health insurers from overcharging the government by billions, but was abruptly withdrawn due to industry pushback. The Justice Department alleges that UnitedHealth Group defrauded Medicare out of $2 billion by adding extra diagnoses to bill higher rates, while ignoring overcharges. This case reveals the struggle to regulate private plans targeting seniors, pointing to issues with chart reviews. The gap in oversight raises red flags about powerful health plans influencing policy. Analysts argue the tactic inflates costs and leads to undeserved payments, highlighting concern over the industry’s practices.
https://kffhealthnews.org/news/article/medicare-advantage-overbilling-diagnostic-codes-cms-killed-rule/