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From Report on Medicare Compliance - A Chicago-area physician pled guilty to taking kickbacks for prescribing an anti-psychotic drug and settled related false claims allegations in a case that represents the kinds of relationships that are coming to light now that the Physician Payments Sunshine Act database is open for business. In the criminal case, Michael J. Reinstein, M.D., pled guilty to one count of violating the anti-kickback statute in connection with almost $600,000 he received from two pharmaceutical companies in exchange for prescribing clozapine to patients, the Department of Justice and U.S. Read more

From Health Plan Week - March 4 is the date the Supreme Court has scheduled for oral arguments in the King v. Burwell case, which — depending on who you talk to — could unravel the public exchanges and leave health insurers in a major reshuffle of their individual market strategizing for years to come, if the decision goes against the Obama administration. While a court decision on whether the Affordable Care Act (ACA) allows… Read more

From Inside Health Insurance Exchanges - If the court rules against HHS in King v. Burwell, some Republican lawmakers will become more vocal about the need to repeal the Affordable Care Act (ACA). But a growing number of conservative lawmakers are likely to pursue a strategy that allows subsidies to remain, in some form, if the Obama administration is willing to remove other provisions, such as the individual and employer mandates, says Stuart Butler, a senior… Read more

From Medicare Advantage News - Nearly half of the entities now operating Medicare Advantage plans are provider-sponsored, and that figure is likely to keep rising, according to a speaker at a Jan. 21 AIS webinar on narrow-network MA plans. But Gary Jacobs, managing director in the Health Industries Advisory practice at PricewaterhouseCoopers and a former top executive at MA insurer Universal American Corp., also said that providers intent on entering MA will need “new competencies”… Read more

From Specialty Pharmacy News - The home infusion industry is hoping that the fifth time’s the charm for bills recently proposed in the U.S. Senate and the House that seek to offer comprehensive Medicare coverage for home infusion. The Medicare Home Infusion Site of Care Act of 2015 seeks to amend the Social Security Act to allow the home to be a covered infusion site of care for Medicare beneficiaries. If passed, it would apply… Read more

From Report on Medicare Compliance - Although encryption of patient data is not a hard and fast regulatory requirement, it’s sneaking in the back door. The HHS Office for Civil Rights is levying fines on health care organizations for lost unencrypted laptops, and encryption of electronic health records must be available to hospitals and physicians for vendors to be certified for stage two of meaningful use. On top of that, the Feb. 6, 2014, HIPAA/CLIA regulation that… Read more

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