UnitedHealth Group loses in overpayments case

The U.S. Court of Appeals for the District of Columbia Circuit Friday reversed a 2018 district court decision in favor of UnitedHealth Group, rejecting the insurer’s claims that a Centers for Medicare & Medicaid Services’ rule requiring Medicare Advantage plans to report and return identified overpayments within 60 days results in underpayments.

“In sum, nothing in the Medicare statute’s text, structure, or logic applies actuarial equivalence to its separate overpayment-refund obligation, and thus the Overpayment Rule does not violate actuarial equivalence,” the opinion states. For much the same reasons, we reject UnitedHealth’s claim that the Rule violates the statute’s ‘same methodology’ requirement, and we also deny its claim that the Rule is arbitrary and capricious as an unexplained departure from prior policy. We therefore reverse the district court’s grant of summary judgment to UnitedHealth and its resulting vacatur of the Overpayment Rule and remand for the district court to enter judgment in favor of CMS.”

In other news last week, UnitedHealth Group and its affiliates agreed to pay over $13 million to resolve federal, state and private litigation alleging violations of federal and state mental health parity laws.