Humana Sues U.S. Government To Block Medicare Advantage Overpayment ‘Clawback’ Rule

Humana sued the U.S. government to block a new Medicare policy to force Medicare Advantage plans to repay overpayments. The lawsuit alleges that the Centers for Medicare and Medicaid Services (CMS) “did not even try” to justify the new policy or its approach for determining whether plans had been overpaid.

CMS had issued a rule about the new policy in January 2023. The policy allows CMS to recoup overpayments if an audit of a Medicare Advantage plan finds charges for diagnoses not in beneficiary medical records. The rule would apply retroactively.

The lawsuit says the rule was “arbitrary and . . .