STAT+: Humana sues Biden administration over Medicare Advantage audit rule
Humana sued the federal government Friday over a rule that claws back overpayments from it and other Medicare Advantage insurers.
Humana sued the federal government Friday, arguing that this year’s new rule to claw back overpayments from it and other Medicare Advantage insurers violates federal law due to its “shifting justifications and erroneous legal reasoning.”
“The [Centers for Medicare and Medicaid Services] did not even try to offer an empirical or actuarial justification for its new audit methodology, relying instead on purely legal rationales — none of which withstand scrutiny,” Humana said in the lawsuit.
The health insurance industry has threatened a lawsuit over this old and contentious auditing process since last year. Humana executives specifically mentioned at this year’s J.P. Morgan Healthcare Conference that they would consider suing the government if the audit rule did not contain certain components they deemed were necessary.
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