Payers, providers and tech companies back UnitedHealthcare efforts to get U.S. Supreme Court to strike down a rule that would make them liable for false claims law violations if Medicare Advantage doesn’t return billions of dollars in overpayments they received .

An overpayment occurs when a diagnostic code sent to the Centers for Medicare and Medicaid Services for payment is not recorded in a patient’s medical record. Medicare Advantage plans must return the overpayment to the federal government within 60 days of identifying the overpayment, or it will be considered a violation of federal law and subject to civil action, damages and penalties.

The overpayment rule, introduced in 2014, was designed to curb escalation and fraudulent billing. The Medicare Payments Advisory Committee estimates that private plans inflated patient conditions in 2020 resulting in about $12 billion in excess payments to plans by the federal government.

United Medical In February of last year, a lower federal court overturned in the District of Columbia Court of Appeals Free up rules.

Health insurance lobby group AHIP, physician support provider Agilon Health, the American Physician Group and the U.S. Chamber of Commerce filed an amicus brief to the court on Friday, arguing that the rule unfairly imposes stricter pressure on private payers by underpaying health plans and , thus threatening the future standard of Medicare Advantage to be higher than the traditional fee-for-service system.

“We are pleased that these high-profile and diverse groups are supporting our efforts to help ensure millions of seniors continue to receive quality care through a growing pool of Medicare Advantage plans,” a UnitedHealthcare spokesperson wrote in an email.

AHIP wrote in its amicus curiae briefing that a lack of medical record documentation does not mean a patient is ill — providers may not be able to update personal medical records at all. The health insurance lobby writes that the overpayment rule ties Medicare Advantage reimbursement to imperfect data on the fee-for-service system.

“Because CMS develops its model using FFS data known to contain a large number of diagnostic codes not recorded in medical records, it cannot require more stringent (Medicare Advantage organization) documentation without adjusting for this inconsistency,” AHIP said.

America’s Physician Groups wrote that the rule could reduce the flat fee CMS pays Medicare Advantage plans and providers to manage patient risk, which could result in the organization reducing the benefits and benefits available to the plan’s 28 million beneficiaries and select patients. The number of treatment options is in its amicus brief. by 2025more than half of eligible Medicare enrollees will be enrolled in a Medicare Advantage plan.

“MA programs and providers facing greater risk and reduced foot traffic have a strong incentive to seek healthier beneficiary populations to make up the difference,” the physician group wrote.

Agilon Health wrote in an amicus brief that because Medicare Advantage plans are paid in the same way as traditional Medicare in order to provide members with more benefits, reimbursement for private plans will be reduced to less than traditional Medicare rates, Thus allowing the public plan to prevail.

“Capital funding has both upside potential and downside risks,” the tech company said. “By effectively forgoing actuarial equivalence, CMS significantly limits upside while significantly expanding downside.”

The U.S. Chamber of Commerce wrote in its report that CMS has a conflict of interest in promoting regulations that reduce payments to Medicare Advantage plans because the plan is funded from the agency’s pocket and because CMS’ traditional health insurance plans compete with private insurers’ plans . An amicus brief.

“In short, CMS has two hats: competitors and referees,” the business group said.

UnitedHealthcare is the largest Medicare Advantage insurance company in the United States, with 7.9 million enrollees.

The whistleblower lawsuit criticizes it and other insurers for allegedly combing through patients’ medical records to find and report all possible diagnoses to submit additional Medicare payments, but fail to remove codes they know are inaccurate. Aetna, Humana, Kaiser Permanente and other insurers are all targets of 2021 Medicare Advantage upgrade coding audits or lawsuits.