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 31, 2015

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(1) The Nevada Health Consumer Operated and Oriented Plan (CO-OP) is shutting down operations at the end of the year .... (more)

(2) A California physician was convicted in connection with a fraud scheme involving unapproved intrauterine devices (IUDs) .... (more)

  From the AIS Blogs
  Is Maryland — which bills itself as The Free State — in its burgeoning provider-owned Medicare Advantage product lines, a harbinger of the future in MA or just an anomaly as usual? Join the conversation at the AIS Blogs.

(3) Republican presidential hopeful Wisconsin Gov. Scott Walker on Aug. 18 unveiled a health care reform proposal intended to replace the Affordable Care Act (ACA) if he were to win the White House. Without saying how he would pay for the plan, Walker said its centerpiece is refundable tax credits to individuals who do not have employer-based coverage. "This would strengthen health insurance markets by enabling individuals to use their tax credits to buy insurance outside the workplace," he said. Some elements of the ACA would remain, such as the ban on denial of coverage for pre-existing medical conditions. But states would assume more power to reject or accept the federal reforms, including whether to allow adult children to remain on parental plans.(From Inside Health Insurance Exchanges' E-Alert)

(4) The Arkansas Insurance Dept. on Aug. 25 said rate increases approved for the 2016 plan year were held below 10%. Individual products sold by Arkansas Blue Cross and Blue Shield, the biggest player on the exchange, will increase by an average of 7.15%, while premiums for its small-group plans will increase 3.01%. Individual plans sold by Celtic Insurance Co., a subsidiary of Centene Corp., will increase just 0.08%, and QualChoice, part of Catholic Health Initiatives, will reduce its individual coverage rates by an average of 8.2%. In 2015, three carriers sold coverage through the exchange. UnitedHealth Group will join them for the 2016 plan year. (From Inside Health Insurance Exchanges' E-Alert)

  From Congress and the Federal Agencies

(5) Eleven out of the 20 Medicare Pioneer accountable care organizations earned shared savings during the third performance year of the program .... (more)

(6) An Illinois appellate court on Aug. 21 affirmed a lower court’s ruling that Cigna Corp. did not steal trade secrets from Destiny Health, Inc. in designing its wellness program .... (more)

(7) Cigna recently agreed to settle an Employee Retirement Income Security Act (ERISA) lawsuit between two of its Texas subsidiaries and two providers for allegedly misrepresenting themselves in claims submitted to the insurer .... (more)

(8) Quest Diagnostics paid $1.79 million to settle a False Claims Act lawsuit .... (more)

(9) Plains Township is suing Highmark Health over a $90 million donation Blue Cross of Northeastern Pennsylvania (BCNEPA) made before it was acquired by Highmark .... (more)

(10) UPMC Medical Center on Aug. 10 again petitioned the Pennsylvania Supreme Court to reconsider its decision that the health system is obligated to continue serving Highmark Health’s Medicare Advantage members .... (more)


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