[JURIST] New records released [press release] by the Center for Public Integrity (CPI) [official website] Wednesday revealed a confidential legal battle over Medicare over-billing that spanned three years between government officials and UnitedHealth Group [official website]. The dispute centered on a 2012 audit obtained through the Freedom of Information Act [official website] that revealed UnitedHealth charged too much for Medicare Advantage plans in nearly half of a sample of 201 patients enrolled at PacifiCare of Washington state, a subsidiary of UnitedHealth Group. Although the insurer has failed to comment on the new information, it has argued that the “audit was unfair and the results were flat out wrong.” The Centers for Medicare & Medicaid Services’ (CMS) [official website] audit used the patients’ medical information and billing documents from UnitedHealth and compared the Medicare cost to the risk score [CPI backgrounder] attributed to their degree of health and determined the amount of over-billing to be $381,776. CPI also revealed information obtained from a 2011 CMS presentation that estimated Medicare payment errors amounted to $13.5 billion in 2010, however, a final payment recovery strategy has yet to be announced.

Comprehensive health care reform [JURIST backgrounder] was passed by Congress in March 2010 after over a year of congressional debate. The Patient Protection and Affordable Care Act (ACA) [text, PDF] was aimed at both reforming the private health insurance market and ensuring greater access to health insurance coverage. However, since the bill was signed into law it has been the subject of numerous federal lawsuits challenging its constitutionality. Most of these lawsuits have revolved around the law’s individual mandate provisions–which requires that all non-exempt US citizens obtain minimum health insurance coverage. In January the Obama Administration announced [JURIST report] the president would veto proposed legislation that would reinstate the 40-hour work week requirement for employer health care coverage. In March the US Supreme Court heard oral arguments [JURIST report] in King v. Burwell to determine whether the IRS may adopt regulations to extend tax-credit subsidies to coverage purchased through the federal health insurance exchange.