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

November 17, 2014

You must be a registered user on to access the stories below. If you haven't yet registered, please take a minute to register now, and get access to thousands of articles, blogs, Today from Washington postings and more.

(1) The Supreme Court said on Nov. 7 that it would take up King v. Burwell (14-114) during its current session in order to determine if premium subsidies awarded to 4.7 million enrollees on were illegal because the wording of the Affordable Care Act (ACA) indicates that only exchanges set up by states can issue subsidies .... (more)

(2) A set of answers to frequently asked questions (FAQ) issued on Nov. 6 by HHS and the departments of Treasury and Labor clarifies that an employer would run afoul of the Affordable Care Act (ACA) if it reimburses an employee for the purchase of an individual market plan .... (more)

  From the AIS Blogs
  Following the FDA approval of more effective treatments, Vertex Pharmaceuticals withdrew its hepatitis C drug Incivek from the U.S. market earlier this month. Do you think this was the right decision for Vertex, or should Incivek still be available as an alternative to the newer and more costly drugs? Join the conversation at the AIS Blogs.

(3) CMS is proposing that Medicare cover an annual screening for lung cancer with low dose computed tomography (LDCT) as an additional preventive service benefit .... (more)

(4) CareAll Management LLC and its affiliates agreed to pay $25 million to settle false claims allegations in a home health care case .... (more)

  From Congress and the Federal Agencies

(5) The Obama administration is predicting far fewer people will enroll in coverage through a public insurance exchange for 2015 .... (more)

(6) A new Government Accountability Office (GAO) report (GAO-15-58) released on Nov. 13 said the health reform law’s exchanges for small businesses are failing to attract interest, echoing what health insurance industry stakeholders have been saying for months .... (more)

(7) Queen’s Medical Center in Honolulu was overpaid $318,587 after making mistakes on 49 of 223 claims audited .... (more)

(8) Cigna Corp. agreed to cap costs for Florida members using HIV/AIDS prescription drugs .... (more)

(9) The cost of operating the call center for Colorado’s state-run insurance exchange is expected to jump by $4 million .... (more)

(10) Hospitals were overpaid for replaced cardiac devices by two Medicare administrative contractors (MACs), which had sequential responsibility for jurisdiction 15 (Kentucky, Ohio and West Virginia) .... (more)

(11) Premiums for Covered California’s Small Business Health Options Program (SHOP) should increase by 5.2% on a statewide weighted average basis for the 2015 plan year .... (more)


Content questions or suggestions should be directed to Executive Editor Jill Brown at If you are interested in advertising in GOVERNMENT NEWS OF THE WEEK please contact Bailey Sterrett at

GOVERNMENT NEWS OF THE WEEK is copyrighted and protected by federal law. The re-use of its content is restricted (see below). However, you are permitted to forward this email to as many of your friends and colleagues as you wish, or better yet have them sign up for their own copy at atlantic_subscription.cfm, where you can also sign up for AIS's Health Business Daily and Spotlight on Health Insurers.

Copyright © 2014 Atlantic Information Services, Inc. (AIS). All rights reserved. It is not permissible to include all or any portion of this content on any Web site, intranet or electronic network or in any print publication, without AIS's written permission in advance. Permission requests should be directed to


Free White Papers, Studies and Surveys

Upcoming Webinars
Save $50!

What CMS’s 2015 Benchmarks and Landscape Files Mean for MA and Part D Product Planning and Marketing
Tues., Nov. 18, 2014
Click here for details

Hepatitis C Treatment: Payer Strategies to Improve Outcomes and Contain Costs
Mon., Dec. 8, 2014
Click here for details

Medicare Plans Serving the Disadvantaged: Strategies for Overcoming the Growing Financial Crunch
Thurs., Dec. 11, 2014
Click here for details

Missed a Live Event?
Listen at your convenience to recent webinars with On-Demand or CD options!
A Guide to Complying With Stark Physician Self-Referral Rules
Complying With Medicare Part D Pharmacy Access Rules: Strategies for Health Plans and PBMs
Medicare Advantage News