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!

March 2, 2015

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 and more.

(1) CMS Administrator Marilyn Tavenner in a Feb. 25 blog post said the agency recently successfully completed the first week of end-to-end testing of the new ICD-10 coding system .... (more)

(2) CMS on Feb. 20 said it is establishing a special enrollment period for individuals and families who did not possess health insurance in 2014 and are subject to a fine when they file their 2014 taxes in states using federally facilitated exchanges (FFEs). The action follows similar moves in some states. “For those who were unaware or didn’t understand the implications of the fee for not enrolling in coverage, CMS will provide consumers with an opportunity to purchase health insurance coverage from March 15 to April 30. If consumers do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes,” CMS said. To be eligible, people must not only live in FFE states, but also not be currently enrolled in coverage for 2015, attest that when they filed their 2014 tax return they paid the fee for not having coverage in 2014 and attest that they understood the implications of the fine/fee after the end of open enrollment on Feb. 15, 2015. (From Inside Health Insurance Exchanges' E-Alert)

  From the AIS Blogs
  If SCOTUS Says No Way to Subsidies, How Bad Will It Be for Plans? Join the conversation at the AIS Blogs.

(3) A coalition of 53 senators, led by Charles Schumer (D-N.Y.), on Feb. 20 sent a letter asking CMS not to further cut payment rates to the Medicare Advantage program, saying it creates disruption in seniors’ health care .... (more)

(4) In the first criminal case the U.S. Attorney’s Office in South Florida has brought on alleged fraud via up-coding of Medicare Advantage diagnoses, the feds this month obtained a grand-jury indictment against a Palm Beach County physician accused of causing at least $2.11 million in excessive MA payments .... (more)

  From Congress and the Federal Agencies

(5) CMS disallowed grandfathered health plans that don’t meet the minimum value requirements, including those that exclude hospital coverage .... (more)

(6) Aetna is expanding its accountable care agreement with Marlton, N.J.-based Virtua Medical Group .... (more)

(7) CMS has accepted Yorkville Endoscopy LLC’s plan of correction, so it will remain in Medicare and Medicaid .... (more)

(8) Aetna on Feb. 23 filed a lawsuit in the U.S. District Court for the Southern District of Texas against Houston-area hospital CEO Robert A. Behar, M.D., for allegedly orchestrating an illegal kickback scheme involving payments to doctors for referrals .... (more)

(9) The IRS on Feb. 23 issued a notice asking for stakeholder feedback on the Cadillac tax, the 40% excise tax that will be levied on high-cost health insurance plans starting in 2018 .... (more)

(10) In new reports, the HHS Office of Inspector General says two more hospitals were overpaid for Kwashiorkor, a form of severe protein malnutrition that is rare in the United States .... (more)

(11) The chairperson of Georgia’s House Health and Human Services on Feb. 10 called Blue Cross and Blue Shield of Georgia, a unit of Anthem, Inc., a “bully” and said the insurer “disrespected” the committee after failing to send a representative to a panel discussion on provider complaints .... (more)

(12) A New Jersey family physician was arrested on Feb. 23 and charged with defrauding Medicare, Medicaid and private payers by billing for office visits that allegedly never happened .... (more)

(13) The HHS Office of Inspector General (OIG) on Feb. 24 said it would add five to 10 ACA-focused investigations in 2015, addressing issues like health care subsidy payments and personal data security .... (more)

(14) The House Ways and Means Committee on Feb. 26 approved a bipartisan program-integrity bill, the Protecting the Integrity of Medicare Act of 2015 (H.R. 1021) .... (more)

(15) CMS on Feb. 25 said of the 8.4 million individuals who selected a plan for 2015 on the federally facilitated exchanges, 4.67 million or 53% were new enrollees .... (more)

(16) The Kentucky Court of Appeals denied Medicaid managed care plan Kentucky Spirit’s plea for an early release from its state contract without a penalty .... (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 © 2015 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


AIS E-Savings Club Weekly Specials

Upcoming Webinars
Save $50!

CMS’s ‘45-Day Notice’ and Preliminary Call Letter: Implications and Strategies for MA and Part D Plans
Thurs., March 12, 2015
Click here for details

Health Insurance Benefit Design 2016: Insurer Strategies for Large Groups
Tues., March 24, 2015
Click here for details

Missed a Live Event?
Listen at your convenience to recent webinars with On-Demand or CD options!
AIS's Directory of Health Plans: 2015 - Shipping Now!
PBM Formulary Exclusions: Bottom-Line Strategies for Health Plans
Dual-Eligibles Initiatives: What’s Working? What’s Not? What’s New?