Business Strategy Consultant | Revenue Cycle Management | M&A | Healthcare Innovation | VBC
Humana's MA Clawback Lawsuit to move forward. A federal judge has ruled that Humana's challenge to a CMS rule implementing stricter auditing standards on MA plans can proceed. 👨⚖️ Humana's lawsuit against CMS's new risk-adjustment rules will proceed despite HHS's attempt to dismiss it 💲 The new rules aim to recover $4.7 billion in overpayments to MA plans over the next decade. 🔻 Humana, the second-largest Medicare Advantage insurer, is facing the largest substantial financial risk. Due to potential clawbacks, it will lose up to 17% of its 2023 earnings, a staggering $900 million. This is a significant concern, especially with the MA market expected to grow and 6.1 million MA members currently enrolled in Humana's plans. With the lawsuit moving forward, it's crucial to consider: Will this decision lead to increased scrutiny of MA plans? What could be the potential implications for patients and providers? How will CMS's new audit methodology affect the financial sustainability of MA plans, and what are the potential consequences for the healthcare industry? Considering the recent HHS vs. SCAN win, the government's increasing momentum in its efforts to recover alleged overpayments and its commitment to ensuring the financial sustainability of the MA program is highlighted. #MedicareAdvantage #Humana #HHS #HealthcareLaw #RiskAdjustment #CMS #Clawback #HumanaMA #HealthcareRegulation https://lnkd.in/gy_FgiRK
