Federal judges question government arguments in Humana Medicare Advantage lawsuit

STAT News reported that federal appeals court judges questioned Health and Human Services Department arguments on Monday during a hearing over Medicare Advantage auditing rules. The hearing involved a lawsuit brought against the government by insurer Humana. [1][3]

According to STAT News, Humana is the second largest Medicare Advantage insurer in the United States. In its 2023 lawsuit, Humana v. Kennedy, the insurer challenged the final rule created by the Health and Human Services Department for auditing Medicare Advantage plans. In a separate report, lhindependent.com reported that CHRISTUS Health Plan plans to withdraw from Medicare Advantage. [1][2][3]

Medicare Advantage is a private health plan option that wraps around traditional Medicare to help fill coverage gaps. Originally permitted under the Social Security Act of 1965, the program was expanded under the Medicare+Choice framework in 1997 and restructured by the 2003 Medicare Prescription Drug, Improvement, and Modernization Act. By March 2025, enrollment reached 34.1 million beneficiaries, representing 54 percent of eligible Medicare beneficiaries. [4][6]

The Medicare Advantage program emphasizes coordinated care models, including health maintenance organizations and preferred provider organizations. These private plans frequently use network restrictions and prior authorizations to manage healthcare utilization across the system. [4][6]