Government News of the Week
Medicare Compliance, HIPAA, Medicare Advantage and Part D,
Health Care Reform, and Other Federal and State Government Developments
Government News of the Week is a weekly email newsletter with timely news stories from Washington, D.C., and the 50 state capitals. Articles are selected for their impact on hospitals, health plans, medical group practices, physicians and other health care providers. Subscribe now to get an issue delivered to your inbox every Monday!
 

June 29, 2015

Note: AIS's Government News of the Week will not be published next week. The next issue will be sent on July 13.

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(1) King v. Burwell (14-114) came out the way the Obama administration wanted, with the Supreme Court on June 25 ruling 6-3 in favor of maintaining federal tax subsidies for enrollees on all Affordable Care Act (ACA) exchanges, no matter if it is a state-run marketplace or a federally facilitated model .... (more)

(2) In a 244-154 vote, the U.S. House of Representatives on June 23 voted to abolish the Independent Payment Advisory Board (IPAB) .... (more)


  From the AIS Blogs
  What do you think will happen with the duals demos in Massachusetts — and elsewhere — in light of slow-to-develop cost savings? Since seemingly everybody agrees that the goals of the demo, especially true coordinated care for one of the nation’s most vulnerable and costly populations, are absolutely correct, what is the major problem, and how can it be solved? How do we prevent what was conceived of as a great opportunity for both plans and beneficiaries from becoming just a footnote in a history book about well-intentioned failures? Join the conversation at the AIS Blogs.

(3) Regulators from the Federal Trade Commission (FTC) and the HHS Office of Inspector General (OIG) are signaling increased scrutiny of accountable care organizations and other value-based payment arrangements, especially those making “creative” use of the antitrust and fraud and abuse waivers in place for Medicare ACOs .... (more)

(4) It’s being hailed as the largest-ever crackdown on health care fraud. More than 240 people — including dozens of doctors and nurses — were arrested for their alleged participation in false Medicare billings worth an estimated $712 million .... (more)


  From Congress and the Federal Agencies
 

(5) In a rare court decision challenging two provisions of the Stark law, the U.S. Court of Appeals for the District of Columbia upheld one provision in favor of HHS and remanded the second for further review .... (more)

(6) Covered California, the state-run ACA exchange, said it will start collecting insurance company data on its 1.4 million enrollees to better assess the quality of care being delivered .... (more)

(7) Hebrew Homes Health Network Inc. and its former president, William Zubkoff, agreed to pay $17 million to settle false claims allegations over payments to physicians for referrals .... (more)

(8) The U.S. Attorney’s Office for the Middle District of Florida filed a false claims lawsuit against Liberty Ambulance Services, Inc .... (more)

(9) Medicare Part D spending for commonly abused opioids (i.e., Schedule II and III opioids) rose significantly between 2006 and 2014, outpacing both the growth in spending for all Part D drugs and the growth in the number of beneficiaries receiving Part D drugs .... (more)

(10) HHS’s Health Resources and Services Administration, which administers the 340B Federal Drug Pricing Program, on June 17 published a new proposed rule pertaining to pharmaceutical manufacturers participating in the program .... (more)

(11) A Missouri federal judge approved Anthem’s $6.25 million settlement of a putative class action lawsuit over unsolicited phone calls .... (more)

(12) The more than 100 pending class actions suits related to Anthem’s cyber attack (The AIS Report 3/15, p. 1)will be heard in the Northern District of California .... (more)

(13) Two consolidated antitrust class-action lawsuits against 37 Blues plans are moving forward in Alabama .... (more)

 

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