Humana sues U.S. government to block Medicare clawback rule

 Humana on Friday sued the U.S. government to block a Biden administration policy that would let Medicare claw back billions of dollars of payments to insurers.

The lawsuit in federal court said the Centers for Medicare and Medicaid Services "did not even try" to justify its more aggressive approach toward determining whether private Medicare Advantage plans for people age 65 and older were overpaid.

Humana's lawsuit challenges a rule announced on Jan. 30 that would let the government recoup payments when audits uncover charges for diagnoses that are not in patients' medical records.

The administration said the increased oversight could help the government collect as much as $4.7 billion over 10 years.

Humana said the rule was "arbitrary and capricious," and threatened "unpredictable consequences for Medicare Advantage organizations and the millions of seniors who rely on the Medicare Advantage program for their healthcare."

CMS is part of the U.S. Department of Health and Human Services. The agency did not immediately respond to a request for comment.

Humana filed its lawsuit with the U.S. District Court in the Northern District of Texas, which has in recent years been sympathetic toward some challenges to federal rulemaking.

The case was assigned to U.S. District Judge Reed O'Connor, a Fort Worth judge who previously declared unconstitutional all or part of the Affordable Care Act, also known as Obamacare.

https://finance.yahoo.com/news/humana-sues-block-medicares-clawbacks-153147681.html