Health Law Highlights

Humana Can Challenge Medicare Clawback Rule

Summary of article from Reuters, by Brendan Pierson:

Humana can proceed with its lawsuit against a Biden administration rule that enables Medicare to reclaim overcharges from insurers. The rule, established in January 2023, permits the government to recoup payments to Medicare Advantage plans when audits reveal charges for diagnoses not present in patients’ medical records. The Biden administration believes this could help recover around $4.7 billion over a decade. Humana argues the rule is “arbitrary and capricious,” with potential unforeseen consequences for Medicare Advantage organizations and beneficiaries. The judge rejected the administration’s request to dismiss the case, stating that the perceived risk of future harm was enough to establish standing.