Government News of the Week
Medicare Compliance, HIPAA, Medicare Advantage and Part D,
Health Care Reform, and Other Federal and State Government Developments

April 14, 2014

NOTE: Government News of the Week will not be published April 21. The next issue will be April 28.

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(1) HHS Sec. Kathleen Sebelius has resigned and President Obama will nominate Sylvia Mathews Burwell, the director of the Office of Management and Budget, to be her replacement .... (more)

(2) A federal agency cannot promulgate a final rule with a provision that is not a “logical outgrowth” of what had been proposed, according to a new ruling from the U.S. Court of Appeals for the District of Columbia Circuit .... (more)

  From the AIS Blogs
  Academic researchers often display a fondness for using several-years-old data to form conclusions about current issues. Often those data are the best available, and the conclusions aren’t affected by the age of the data. But this may not be the case when the subject deals with payments for Medicare Advantage plans, and a recent study published by the National Bureau of Economic Research — and getting widespread attention in light of the spirited debate about 2015 MA pay rates — might be an example. Join the conversation at the AIS Blogs.

(3) The Montana Insurance Commissioner issued a $250,000 fine — the largest fine ever for an insurance company in that state — after a market conduct exam turned up violations based on Blue Cross and Blue Shield of Montana operations between 2006 and 2010 .... (more)

(4) Michigan’s unique Care Bridge model of care for Medicare-Medicaid dual eligibles got its long-awaited approval from CMS April 3 as the agency gave the go-ahead for the state’s three-year duals demonstration program .... (more)

  From Congress and the Federal Agencies
  A daily listing of health business developments

(5) Massachusetts nonprofit Harvard Pilgrim Health Care, Inc. has received its license to sell health insurance in Connecticut and will sell policies starting in the second quarter of 2014 in the small and large group markets with coverage taking effect July 1 .... (more)

(6) Cook County Health & Hospitals System requested approval from its board to award Centene Corp. a five-year contract to run day-to-day operations of its Medicaid managed care initiative, CountyCare .... (more)

(7) CMS has instructed Medicare administrative contractors to wait 45 days after educating hospitals on their compliance with the two-midnight rule under the “probe and educate” program before making additional documentation requests .... (more)

(8) Medicare overpaid $2 billion for home health services that were not compliant with the requirement that physicians have a face-to-face encounters with patients they certify as eligible for home health care .... (more)

(9) A national network of clinical labs may run afoul of the anti-kickback law by providing free software to physicians depending on the parties’ intent .... (more)


Have breaking news or an editorial question? E-mail BJ Taylor, editor of GOVERNMENT NEWS OF THE WEEK, at If you are interested in sponsoring GOVERNMENT NEWS OF THE WEEK please contact Bailey Sterrett at

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