Why UnitedHealthcare's Litigation Against CMS Is Unique

By Ursula Taylor (August 14, 2017, 12:23 PM EDT) -- My mother always told me that if I wanted something done my way, then I ought to do it myself. These wise words are exemplified by the recent litigation efforts of UnitedHealthcare ("UHC") in its quest to rectify a Centers for Medicare and Medicaid Services overpayment rule, described here, that it alleges results in significant underpayments to Medicare Advantage organizations. As the nation's largest Medicare Advantage insurer, UHC has initiated affirmative litigation under the Administrative Procedures Act (the "APA") seeking to set aside CMS' 2014 overpayment rule on the grounds that the rule violates the requirement of "actuarial equivalence" under the Medicare Act and imposes an improper negligence standard that lacks statutory authority. UnitedHealthcare Insurance Company v. Price, No. 16-cv-157 (D.D.C.). UHC's claims have industry-wide implications, and a positive ruling would equally benefit other Medicare Advantage organizations. Yet, those that may be hoping to ride on UHC's coattails and benefit from a swift and clean victory under the APA would be well served to understand UHC's unique litigation position, including the fact that UHC is a defendant in multiple unsealed whistleblower lawsuits alleging that UHC violated the False Claims Act in connection with its Medicare Advantage payments and processes....

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