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

September 15, 2014

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(1) Despite its previously stated plans to stop renewing the contracts of Medicare Advantage (MA) and Prescription Drug Plan (PDP) organizations that fail for three consecutive years to achieve at least three stars at the end of 2014, CMS in a new memo says it will not exercise this authority for 2015 .... (more)

(2) California’s Assembly on Aug. 28 voted 52-18 in favor of legislation to increase scrutiny of insurers’ narrow provider networks .... (more)

  From the AIS Blogs
  The start to last year’s debut of public health insurance exchanges could not have gone much worse … but despite the glitch-filled opening, processes began functioning pretty well in early 2014, and the extended open-enrollment period concluded with about 8 million people enrolled in a private insurance policy. So we’re all good, right? Join the conversation at the AIS Blogs.

(3) An Indiana spine surgeon and a company that manufactures devices used in spinal surgery agreed to pay $2.6 million to settle false claims allegations .... (more)

(4) The political action committee of America’s Health Insurance Plans (AHIP) has favored Republicans so far in the current election cycle, donating $162,500 to Republicans versus $115,500 to Democrats .... (more)

  From Congress and the Federal Agencies

(5) Argus Health Systems, Inc. has agreed to pay the HHS Office of Inspector General (OIG) $2 million to resolve allegations that the Kansas City-based PBM submitted prescription drug event (PDE) data to Medicare that included sales tax from Louisiana pharmacies .... (more)

(6) In a Medicare compliance review, the HHS Office of Inspector General (OIG) determined that Genesis Medical Center in Davenport, Iowa, incorrectly billed 71 of the 357 claims audited .... (more)

(7) The Government Accountability Office (GAO) said in a July 31 report that CMS has not fully developed plans to use encounter data collected on Medicare Advantage .... (more)

(8) Rep. Bill Cassidy (R-La.) on Sept. 9 said his legislation (H.R. 3522) to allow insurers to offer group plans not in compliance with the Affordable Care Act through 2018 would increase federal revenues by more than $1.2 billion over fiscal years 2015 to 2024 .... (more)

(9) CMS this summer imposed a civil monetary penalty on Florida Healthcare Plus, Inc. for issues resulting in delays and denials in Medicare customer care .... (more)

(10) The Center for Medicare Advocacy has filed a class-action lawsuit against HHS over extreme delays in Medicare appeal rulings .... (more)

(11) SummaCare, Inc. last month was placed on intermediate sanctions from CMS that temporarily prevent the Ohio-based Medicare Advantage plan sponsor from enrolling and marketing to new MA enrollees .... (more)

(12) The California attorney general’s office is investigating Medi-Cal’s Gold Coast Health Plan for financial dealings with contractor Xerox Corp. .... (more)

(13) CMS has posted three new settlements stemming from its Stark self-referral disclosure protocol (SRDP), although as usual, the details are sketchy .... (more)

(14) New York health insurers saw their rate requests cut in half in many cases when regulators in the state released 2015 premium prices on Sept. 4 .... (more)


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