Things never move quickly when it comes to lawsuits and the government… 

Here’s a timeline of what has happened: 

• Humana challenged a Medicare rule issued in January 2023 allowing for clawbacks of billions of dollars ($4.7B over 10 years) from insurers.  The government sought to dismiss the case.
• June 2024 – U.S. District Judge Reed O’Connor ruled Humana can proceed with its lawsuit in Fort Worth, Texas. 
• February 2025 – Humana filed a motion requesting a summary judgement to invalidate the clawbacks ruling, CMS responded with a cross motion to uphold the ruling.

What’s next:

• Judge O’Connor’s ruling can now come at any time.
• Regardless of the outcome it is likely the losing party will file an appeal.

What impact does this ruling have on healthcare clinicians?

If the ruling is struck down the outcome will be fewer retroactive clawbacks from CMS and more stability in MA contracts going forward.  If the ruling is upheld insurers will receive those clawbacks and will need the tighten operations potentially impacting MA reimbursements. Clinicians will likely receive even more scrutiny on diagnosis coding and additional pressure to cut costs.

Medicare is certainly not the largest payer for Urgent Care operators, but clawbacks from 10 years of Medicare reimbursements would definitely have an impact on financials.

I’ll keep you posted on any developments in this case… one to watch for sure!