From Report on Medicare Compliance - Dignity Health, the largest hospital system in California, agreed to pay $1.55 million to resolve allegations it didn’t properly handle controlled substances, the U.S. Attorney’s Office for the Eastern District of California said July 16. The San Francisco-based system also will implement an “action plan” to improve compliance with the Controlled Substances Act. The feds said $300,000 of the settlement will be deferred “pending Dignity Health’s compliance over the next two years.” Read more
From Health Plan Week - E-payments are increasingly a part of the payer-provider relationship, but like many other areas that define the give and take between the two sides, the transition to a paperless reimbursement system has not been without its controversies. Read more
From Inside Health Insurance Exchanges - Some insurance agents and brokers who helped individuals and small groups find health coverage through public insurance exchanges are still waiting for commission checks. Some are owed thousands of dollars for work they did last fall. Although commissions typically are paid by the carriers, HHS and some state exchanges have been slow to get the necessary information to the carriers. Read more
From Medicare Advantage News - Commonwealth Care Alliance (CCA), which already has landed about 10,000 members in the new CMS-backed initiative for Medicare-Medicaid dual eligibles in Massachusetts, will get a $10 million loan from a new nonprofit investment fund to help meet state reserve requirements that will soar in light of this huge growth. Read more
From Specialty Pharmacy News - Consumer advocacy groups in California and Florida have taken various actions against health plans and their coverage of HIV/AIDS drugs and requirements for members who take them. And while Consumer Watchdog and The AIDS Institute, in conjunction with The National Health Law Program (NHeLP), are taking somewhat different approaches, they are united in the contention that these members are being discriminated against, and the Affordable Care Act (ACA) bans health… Read more
From Report on Medicare Compliance - With the rapid pace of consolidation in the health care industry, compliance officers need eyes in the back of their heads. When back-office functions — including compliance, legal, revenue cycle, patient financial services, human resources and supply chain management — are centralized, there is a risk the policies and procedures for ensuring integrity will no longer fit or will fall through the cracks. The shape of the health system’s compliance… Read more
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