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

October 20, 2014

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(1) HHS Sec. Sylvia Burwell spent much of an Oct. 9 press conference discussing the two biggest issues facing her office — the Ebola virus and the upcoming open-enrollment period for public insurance exchanges .... (more)

(2) A Yonkers, N.Y., cardiologist was sentenced to three years in prison and ordered to pay $2 million in connection with his June guilty plea for health care fraud .... (more)

  From the AIS Blogs
  What do you think of CMS’s star-ratings dissemination process? How could it be improved? Does the timing of the stars release give insurers enough time to adjust their AEP marketing if they do some planning in advance? Join the conversation at the AIS Blogs.

(3) California’s state-run exchange, Covered California, has awarded $184 million in contracts without bidding or oversight .... (more)

(4) CMS on Oct. 15 released details of how public exchange enrollees can renew their policies for the 2015 plan year .... (more)

  From Congress and the Federal Agencies

(5) A federal judge in Oklahoma blocked an IRS rule that allows the use of subsidies in federal insurance exchanges, saying the language of the ACA directs the tax credits to state-run exchanges only .... (more)

(6) The FDA approved another hepatitis C drug from Gilead Sciences Inc., the maker of Sovaldi .... (more)

(7) Mission Hospital in Asheville, N.C., was overpaid $443,183 during 2011 and 2012 .... (more)

(8) A team of Republican senators petitioned Speaker of the House John Boehner (R-Ohio) to disallow additional appropriations for the Affordable Care Act’s (ACA) risk corridors program .... (more)

(9) California Gov. Jerry Brown (D) on Sept. 25 signed into law a measure (Senate Bill 1052) that requires the state public exchange, Covered California, to build an online search tool to compare health plans’ cost and coverage of certain drugs .... (more)

(10) Obama administration rules allow large employers to offer 2015 health plans to workers that do not include hospital benefits .... (more)

(11) Medical Business Service, Inc., agreed to pay $1.95 million to settle false claims allegations that it changed diagnosis codes on claims submitted on behalf of radiologists to ensure they would be paid .... (more)

(12) Thirty-five state Medicaid programs require prior authorization for hepatitis C drug Sovaldi and several states mandate eligible patients to meet a set of clinical or clinical-related criteria for prior authorization .... (more)


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