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Report on Medicare Compliance
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November 29, 2016

Today's Featured Story

Amid Trump Administration Unknowns, Enforcement, Compliance May Be Stable
Reprinted from Report on Medicare Compliance

A slew of program-integrity measures, including the Medicare-Medicaid 60-day overpayment refund rule, could disappear if President-elect Donald Trump and the Republican-controlled Congress repeal and replace the Affordable Care Act, as they have pledged to do. But there is speculation they are more likely to gut the parts of the law on spending (e.g., the individual and employer mandates, subsidies and the medical-device tax), which will leave intact the compliance and enforcement provisions of the Affordable Care Act, among other things, experts say.... Read Full Story

 

Quote of the Day

“Major changes to the ACA including the elimination of unpopular provisions, like mandate penalties, is virtually certain. However, Republicans will need to advance a replacement plan that addresses insurance coverage for the 20 million people who have been newly covered under the ACA. Furthermore, some provisions of the ACA are broadly popular and very likely to be maintained. For instance, market reforms that permit children to remain on their parents’ insurance to age 26 and guaranteed renewability will remain. Furthermore, provisions like closing the Medicare Part D doughnut hole and creating a biosimilars approval pathway are likely to continue.”

— Caroline Pearson, senior vice president, policy and strategy, at Avalere Health, told AIS’s Drug Benefit News.

Click here to read the DRUG BENEFIT NEWS article in which this quote appeared — "How Will Trump Presidency Impact Drug Prices, Rx Benefits, ACA, Biosimilars?" (Free for DBN subscribers; $17 for non-subscribers.)

 

Today's Datapoint

$70.4 million ... in savings have been experienced in the past 12 months by Anthem Inc.’s accountable care organizations in California under its Anthem Blue Cross brand.

Click here to read the HEALTH PLAN WEEK article in which this datapoint appeared — "Plans Tout New ACO Results, Programs as Anthem, UnitedHealth Expand Their Efforts" (Free for HPW subscribers; $17 for non-subscribers.)

 

Today from Washington

People on the Move

Asterias Biotherapeutics, Inc. promoted Ryan Chavez to chief financial officer. He will also continue to serve as general counsel. Chavez joined Asterias in July 2016 as executive vice president of finance and general counsel. Prior to joining Asterias, Mr. Chavez was vice president and general counsel of Mallinckrodt's Autoimmune and Rare Disease Division....Charlita Shelton, Ph.D., was appointed executive director of Dallas Nursing Institute. She previously served as president of the University of the Rockies....BayCare Health System named Teri Sholder senior vice president and chief quality officer. She previously served as chief quality officer of Kettering Health Network.

 

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