Bipartisan Bill Aims to Curb Medicare Advantage Clawbacks

Reps. Greg Landsman and Bob Onder introduced the Protecting Approved Care Act to amend the Medicare statute, effectively barring insurance plans from shifting coverage parameters after services are completed. The legislation targets the growing trend of insurers issuing prior authorizations only to rescind payment or reduce reimbursement months after the care has been delivered to patients.

AAOS President Wilford K. Gibson highlighted that the current system forces providers to navigate expensive, time-consuming administrative disputes while burdening patients with unexpected bills for procedures they believed were fully covered. Data suggests the strain is acute for vulnerable populations, as 36% of Medicare Advantage enrollees report annual incomes under $25,000. By mandating that organizations honor their initial coverage decisions, the bill intends to reduce physician burnout and restore predictability to the delivery of musculoskeletal healthcare.