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!

October 17, 2016

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(1) Some UnitedHealth Group members in Minnesota sued the company for allegedly defrauding them by secretly overcharging for prescription drugs .... (more)

(2) New guidance from the HHS Office for Civil Rights “debunks potential misunderstandings” about the HIPAA obligations of cloud service providers (CSPs) and the covered entities that use them .... (more)

  From the AIS Blogs
  What do you think is likely to contribute to member enrollment shifts this Annual Election Period? Join the conversation at the AIS Blogs.

(3) CMS has authorized Kentucky’s state-run insurance exchange, kynect, to switch to the federal platform in time for the start of the open-enrollment period Nov. 1 .... (more)

(4) Hospitals may want to take a closer look at their Coumadin clinics because they may be charging for evaluation and management (E/M) services when they’re mainly performing lab tests .... (more)

  From Congress and the Federal Agencies

(5) Mylan N.V. on Oct. 7 said it agreed to pay a $465 million settlement with DOJ over its injectable drug EpiPen’s classification as a “non-innovator drug” under the Medicaid Drug Rebate Program .... (more)

(6) CMS on Oct. 14 finalized the regulation on merit-based incentive payment systems (MIPs) and alternative payment models (APMs), and in tandem announced it will reduce medical reviews for physicians participating in some APMs .... (more)

(7) CMS has selected nine Medicare Advantage organizations (MAOs) operating 11 plans to participate in the first year of the MA Value-Based Insurance Design (VBID) model that kicks off on Jan. 1, 2017 .... (more)

(8) A Sept. 27 letter from the National Association of Insurance Commissioners (NAIC) to House Speaker Paul Ryan (R-Wis.) and Minority Leader Nancy Pelosi (D-Calif.) says it would be illegal for the government to recover start-up loans given to now liquidated Consumer Operated and Oriented Plans before ther parties are paid, such as for CO-OP policyholder claims. At issue is whether the federal government can be first in line for such payments and supersede states in doing so. “The ACA’s purpose was to ensure ‘quality, affordable health care for all Americans.’ Instead of protecting policyholders, the HHS/DOJ [Dept. of Justice] abuse of the federal ‘super-priority’ will have a significant financial impact on policyholders, providers, the states, and state taxpayers. It will also disrupt the orderly liquidation process established by the states, confirmed by Congress, and endorsed by HHS when it promulgated ACA regulations,” NAIC said .... (From Inside Health Insurance Exchanges' E-Alert)

(9) Yavapai Regional Medical Center in Arizona agreed to pay $5.85 million to resolve false claims allegations that it misreported the hours that its employees worked, which caused an inflated wage index for the Prescott, Ariz., area .... (more)


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