Texas judge strikes down federal rule targeting Medicare Advantage overpayments

The rule, finalized in 2023, gave the Centers for Medicare and Medicaid Services (CMS) authority to extrapolate findings from audits of a sample of diagnosis codes across all enrollees of Medicare Advantage insurers. Historically, CMS had recouped overpayments only for diagnoses tied directly to the enrollees included in the sample, according to a report from BestWire.

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