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

July 21, 2014

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(1) UnitedHealth Group filed suit against California Insurance Commissioner Dave Jones (D) for allegedly abusing his power when he imposed a $173 million fine against the insurer over improper medical claims by UnitedHealth unit PacifiCare .... (more)

(2) Halifax Health has agreed to pay $1 million to settle a false claims case alleging it billed Medicare for medically unnecessary short hospital stays, but the Department of Justice and U.S. District Court in Orlando, Fla., still have to sign off on it .... (more)

  From the AIS Blogs
  The scandal at the Department of Veterans Affairs that has so outraged the nation over veterans’ access to medical care also has pointed the spotlight on whistleblower protection laws. Could staff firings in these cases be considered "retaliation"? Join the conversation at the AIS Blogs.

(3) Senate Finance Committee leaders on July 11 asked Gilead Sciences Inc., the maker of controversial hepatitis C drug Sovaldi, to divulge pricing information on the drug, citing information that the original developer of Sovaldi expected to sell the drug profitably at a much lower rate than Gilead markets the medication .... (more)

(4) Five senators sent a letter to the director of the Office of Management and Budget urging OMB to take action on draft guidance it has on how the FDA regulates laboratory developed tests .... (more)

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

(5) Higher-than-expected administrative costs are prompting some state-run insurance exchanges to increase user fees for people who buy coverage. But increasing fees could push coverage costs higher, warn some industry observers .... (more)

(6) CMS issued a proposed rule updating policies and rates under the end-stage renal disease prospective payment system for services provided as of Jan. 1, 2015 .... (more)

(7) Florida Medicaid paid $180,416 for pharmacy items prescribed by excluded providers in 2009 and 2010, the HHS Office of Inspector General said in a July 14 report .... (more)

(8) The vice president of operations for Alpha Diagnostics Services in Owings Mills, Md., pleaded guilty on July 17 to health fraud in connection with an alleged scheme to bill Medicare and other payers for tests that were interpreted by unlicensed personnel or not provided .... (more)

(9) A successful first test of a new platform from hCentive could allow Massachusetts to operate its own exchange this fall rather than joining the federally run marketplace .... (more)



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