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

August 25, 2014

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(1) Enforcement of the Stark law keeps taking new directions, and for the first time it veered into physician compensation inside a practice, unrelated to hospital referrals .... (more)

(2) The Supreme Court is being asked to review a lower court’s decision that confirmed an IRS rule allowing federally run exchanges to distribute federal premium subsidies. In a petition for a writ of certioriari, the attorney for the plaintiff in King v. Burwell asked the Court to review the Fourth Circuit decision .... (more)

  From the AIS Blogs
  Rhetoric in support of MA was in ample supply at a House Ways and Means Health Subcommittee hearing held just before Congress adjourned for the long summer break, but actual legislation to accomplish some of the stated objectives was not. What do you think will be the result of hearings like this? Will they be able to channel support for legislation in the next Congress, if not in this one, to alter the still-coming pay reductions for MA plans? Join the conversation at the AIS Blogs.

(3) Citing $32 million in Medicare Part D spending on HIV drugs that showed inappropriate utilization patterns, the HHS Office of Inspector General (OIG) recommended that CMS pursue a pharmacy “lock-in” program that would limit certain Part D beneficiaries to a restricted number of pharmacies to prevent inappropriate utilization .... (more)

(4) Carondelet Health Network in Arizona, which does business as Carondelet St. Mary’s Hospital and Carondelet St. Joseph’s Hospital, agreed to pay $35 million to settle false claims allegations over inpatient rehabilitation charges .... (more)

  From Congress and the Federal Agencies

(5) The company that helped to build Oregon’s failed insurance exchange is suing the state, claiming it is still owed $23 million in accordance with its contact .... (more)

(6) Officials in Massachusetts have decided not to shift the state’s insurance exchange to the platform for the upcoming enrollment period .... (more)

(7) Almost two decades after teaching physician billing was identified as a compliance risk, it’s back in the limelight with a false claims settlement .... (more)

(8) A government watchdog group gave the IRS a glowing review for providing accurate income and family size information to insurance exchanges for their use in determining eligibility for advance premium tax credits .... (more)

(9) Optim Healthcare in Savannah, Ga., and others agreed to pay $4 million to settle false claims allegations over procedures performed at its rural hospital 90 miles away in Tattnall County .... (more)

(10) White House adviser Valerie Jarrett allegedly colluded with Baltimore-based CareFirst, Inc.’s CareFirst BlueCross BlueShield plan to have it underprice premiums it sold on exchanges with the knowledge the money lost would be made up from the reform law’s risk-corridor program .... (more)


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