CMS published a draft regulation in January 2014 aimed at curbing overcharges in Medicare Advantage, but later dropped it after pressure from the industry.
The DOJ alleges UnitedHealth Group committed fraud against Medicare, claiming they ignored potential overcharges while inflating their revenue through additional patient diagnoses.
UnitedHealth's defense hinges on the argument that they should not be penalized for noncompliance with a rule that CMS proposed but never enacted.
The incident raises concerns about the integrity of Medicare Advantage plans and the vast financial implications of improper billing practices.
#medicare-advantage #unitedhealth-group #health-insurance-fraud #cms-regulations #government-oversight
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