Stories

Judge vacates Medicare Advantage overbilling rule

A nurse checks a patient whose medical records sit on a desk.
A nurse checks the vitals of an elderly patient. Photo: John Moore/Getty Images

A federal judge Friday ruled in favor of UnitedHealth Group by tossing out a federal rule that required Medicare Advantage insurers, like UnitedHealth, to give back payments based on verified diagnosis codes in a medical record even though the traditional Medicare program relies on unaudited codes for payment.

Why it matters: The decision is a huge win for Medicare Advantage companies. It could affect other pending overbilling cases and how the federal government audits the industry that has a track record of inflating patient medical codes. Go deeper: Read more from Modern Healthcare and Fierce Healthcare.