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

July 28, 2014

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(1) In its latest attempt to implement a controversial final rule allowing certain hospitals participating in the 340 Drug Pricing Program to purchase discounted orphan drugs so long as they are used for nonorphan indications .... (more)

(2) Investigators from the Government Accountability Office (GAO) were able to use phony information to obtain health insurance and premium subsidies through the federal exchange on 11 of 12 attempts .... (more)

  From the AIS Blogs
  The drumbeat to do something about mass terminations of providers from MA networks is getting louder, and new legislation introduced in Congress shows the issue isn’t going away any time soon. To what degree do you think the MA industry has brought the probability of greater restrictions on itself by how it has carried out network downsizing? Join the conversation at the AIS Blogs.

(3) While a new section of CMS’s proposed 2015 Hospital Outpatient Prospective Payment System (OPPS) rule governing recovery of overpayments from Medicare Advantage and Part D plans would not change existing payment methodologies .... (more)

(4) A lawsuit over adequate provider networks will take a few steps back following a judge’s early July ruling vacating certain orders made by the previous judge .... (more)

  From Congress and the Federal Agencies

(5) HHS on July 16 issued a letter that explained how health insurers operating in U.S. territories are exempt from certain health reform law marketplace requirements because they are not states .... (more)

(6) Despite perceptions to the contrary, the new national coverage determination for cardiac permanent implantable single-and dual-chamber cardiac pacemakers took effect Aug. 13, 2013 .... (more)

(7) Social Security numbers of about 18,000 California doctors were accidentally released with other data by Blue Shield of California and the state Department of Managed Health Care (DMHC) .... (more)

(8) American International Biotechnology, LLC, agreed to pay $343,739 to settle false-claims allegations .... (more)

(9) A new study conducted by The Moran Group on behalf of the Pharmaceutical Care Management Association (PCMA) estimates that H.R. 4577, a bill that proposes to ensure Medicare Part D beneficiaries access to local pharmacies .... (more)

(10) Consumer Watchdog on July 8 filed a class-action lawsuit alleging that WellPoint, Inc. unit Anthem Blue Cross misled millions of California public-exchange enrollees who bought coverage .... (more)

(11) The owner of Polaris Allergy Labs in East Point, Ga., pleaded guilty to one count of health care fraud for faking the results of allergy tests referred by physicians .... (more)


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