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

October 13, 2014

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(1) CMS on Oct. 7 published a frequently asked questions (FAQ) document that supports reimbursement of the Affordable Care Act fee to Medicaid health plans.... (more)

(2) A proposed rule issued by the HHS Office of Inspector General includes new safe harbors to protect certain pharmacy-related practices from criminal prosecution or civil sanctions under the anti-kickback statute, as well as amends the definition of “remuneration” related to the civil monetary penalties law.... (more)

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(3) CVS Health’s CVS/caremark PBM unit will pay the U.S. $6 million to settle allegations that it knowingly failed to reimburse Medicaid for prescription drug costs that were the responsibility of private health plans administered by the PBM, the U.S. Department of Justice said... (more)

(4) CMS has instructed Medicare administrative contractors (MACs) to get off the sidelines and defend claim denials that are appealed to administrative law judges.... (more)

  From Congress and the Federal Agencies

(5) The U.S. Supreme Court instructed the solicitor general to weigh in on two cases regarding a conflict between state and federal subrogation laws for health insurers seeking reimbursement from patient injury legal damages... (more)

(6) Standards for Medicaid access in managed care plans vary widely from state to state, a Sept. 30 report from the HHS Office of the Inspector General found... (more)

(7) Orlando Health was overpaid roughly $1.453 million for inpatient services, according to a new Medicare compliance review.... (more)

(8) Because their coinsurance was so high, beneficiaries paid almost half the costs of the outpatient services they received at critical access hospitals (CAHs), the HHS Office of Inspector General says in a new report.... (more)

(9) Pennsylvania Blues operator Highmark Inc. is violating a consent decree signed by the insurer and rival University of Pittsburgh Medical Center (UPMC) with its new narrow network Community Blue products for the Medicare Advantage (MA) market, according to state regulators and UPMC... (more)

(10) The Community Hospice, Inc., a nonprofit in Rensselaer, N.Y., inappropriately claimed at least $447,000 in Medicare reimbursement, the HHS Office of Inspector General says in a new report.... (more)

(11) Extendicare Health Services Inc., a skilled nursing facility company, agreed to pay $38 million to settle a false claims lawsuit alleging its nursing services were so deficient that “they were effectively worthless,” the Department of Justice said... (more)


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