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

September 1, 2014

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(1) It takes nearly two computer screens to scroll through the list of state-mandated medical services that health insurers in California must cover. And on Aug. 22, a clarification of an existing state law added one more when the Department of Managed Health Care informed carriers that abortion services are a basic health service in the state and must be covered .... (more)

(2) The vice president and CFO of a durable medical equipment company pled guilty to conspiring to commit health fraud and faces up to five years in prison .... (more)

  From the AIS Blogs
  Some consumer advocacy groups contend that health plans’ placement of HIV/AIDS drugs on high formulary tiers is discriminatory. Could a discrimination case be made on behalf of anyone with a condition that requires him or her to take a drug that’s placed on a high cost-share tier? Join the conversation at the AIS Blogs.

(3) CMS said on Aug. 27 that it completed modifications to its contracts with incumbent recovery audit contractors (RACs) in regions A, B and D, which means they can restart some reviews .... (more)

(4) A group of speakers voiced strong support for the Medicare Advantage program at a July 24 House Ways and Means Health Subcommittee hearing that seemed more designed to let organizations air recommendations for protecting the program than to work for any specific legislation this year .... (more)

  From Congress and the Federal Agencies

(5) CMS on Aug. 11 imposed immediate suspensions of new enrollment and marketing for Medicare Advantage plans on SummaCare, Inc., an Akron, Ohio-based insurer with more than 33,000 MA enrollees in 41 counties in Northern Ohio .... (more)

(6) Hospitals will get some relief from claim denials for sleep studies, formally known as polysomnography .... (more)

(7) Two GOP senators sent a letter to the head of CMS on Aug. 27 asking for a more thorough report on how many people are enrolled in public exchanges ahead of the second open-enrollment period that starts on Nov. 15 .... (more)

(8) Medicare Advantage plans had another big month of enrollment gains in the CMS data released at mid-month for the Aug. 1 payment date .... (more)

(9) A Florida physician has settled a civil monetary penalty case with the HHS Office of Inspector General, agreeing to pay $334,538 over alleged false Medicare claims .... (more)

(10) The Affordable Care Act’s payroll tax requirements for top health insurance executives generated an additional $72 million in federal revenue from the 10 largest publicly traded carriers in 2013 .... (more)


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