Government News of the Week
Medicare Compliance, HIPAA, Medicare Advantage and Part D,
Health Care Reform, and Other Federal and State Government Developments
Government News of the Week is a weekly email newsletter with timely news stories from Washington, D.C., and the 50 state capitals. Articles are selected for their impact on hospitals, health plans, medical group practices, physicians and other health care providers. Subscribe now to get an issue delivered to your inbox every Monday!

August 3, 2015

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(1) It looks like hospitals will soon be required to inform Medicare patients when they are placed in observation instead of admitted as inpatients, something that may be a clinical distinction without a difference but could have an effect on patient copayments and their ability to obtain Medicare coverage for skilled nursing facility (SNF) treatment .... (more)

(2) CMS on July 27 elaborated on its July 6 announcement that for the first year of life in an ICD-10 world, it won’t deny Medicare claims billed under the Medicare physician fee schedule “based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right facility” .... (more)

  From the AIS Blogs
  What do you think of the CMS proposal to try out a bundled payment program for knee and hip replacements in the Medicare program? Is it going to add fuel to the fire for new payment models, or will its flaws (as some say) make it a nonstarter? Join the conversation at the AIS Blogs.

(3) Former Georgia Insurance Commissioner John Oxendine filed a proposed class-action lawsuit against Anthem affiliate Blue Cross and Blue Shield of Georgia, saying the insurer overcharged members after reducing its payments to doctors .... (more)

(4) Two changes to the CMS ACO Investment Model have opened the door to the Medicare Shared Savings Program (MSSP) for rural accountable care organizations that wouldn’t otherwise have been able to join the program .... (more)

  From Congress and the Federal Agencies

(5) Approximately 300,000 people may have paid the ACA's fine for failing to buy coverage when they qualified for an exemption, the Treasury Department said on July 17. Mark Mazur, assistant secretary of tax policy, said in a blog the agency will reach out to those individuals to notify them of their options and allow them to file an amended tax return.  (From Inside Health Insurance Exchanges' E-Alert)

(6) Total enrollment in Medicare Advantage and other prepaid plans increased by 82,708 to 17,532,521 as of the July 1 payment date, compared with the June 1 figures, reflecting enrollments in the 35-day period ending June 12 .... (more)

(7) Eight of the 38 states required to report any encounter data from their Medicaid managed care programs failed to do so in 2011 .... (more)

(8) Twenty-one of the 23 Consumer Operated and Oriented Plans (CO-OPs) established under the Affordable Care Act are losing money, 13 are falling short of enrollment goals and some may be unable to pay back $2.4 billion in aggregate government loans, according to a July 30 report by the HHS Office of Inspector General .... (more)

(9) Providers were overpaid $35.8 million for certain outpatient drugs in 13 Medicare administrative contractor (MAC) jurisdictions between July 1, 2009, and June 30, 2012, according to a new HHS Office of Inspector General (OIG) report (A-09-14-02024) .... (more)

(10) NuVasive Inc., a medical device manufacturer, agreed to pay $13.5 million to settle false claims allegations that it caused providers to submit false claims to federal health programs for spine surgeries in connection with the use of the company’s CoRoent System .... (more)

(11) A Jersey City, N.J., pediatrician was sentenced to 21 months in prison for fraudulently billing Medicaid for 1,000 wound repair procedures that he did not actually perform .... (more)

(12) Anthem, Inc. is facing a potential class-action lawsuit over its refusal to cover the hepatitis C drug Harvoni after a woman filed suit, claiming the insurer declined to pay for the drug because her liver .... (more)

(13) Blue Cross and Blue Shield of Michigan (BCBSM) filed a third-party complaint against Munson Medical Center on July 17 in a lawsuit from a Native American tribe alleging the insurer overcharged tribe members for health services .... (more)

(14) Blue Shield of California is facing a class-action lawsuit after a federal judge in California on July 14 certified a class of 19 plaintiffs, who say the insurer refuses to cover artificial disc replacement back surgery .... (more)

(15) A whistleblower who filed a now-dismissed qui tam lawsuit against CVS Caremark, alleging the retailer violated the False Claims Act (FCA) by incentivizing Medicare and Medicaid recipients to purchase prescriptions through CVS’s pharmacy, is appealing the decision to the Seventh Circuit Court of Appeals in Chicago .... (more)


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