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

You must be a registered user on AISHealth.com 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, Today from Washington postings and more.

(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)


  From the AIS Blogs
  Is competition affecting the price of health insurance on exchanges? Do you expect low-enrollment carriers will stick with the exchanges for 2016? Join the conversation at the AIS Blogs.

(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)

 

Content questions or suggestions should be directed to Executive Editor Jill Brown at jbrown@aishealth.com. If you are interested in sponsoring GOVERNMENT NEWS OF THE WEEK please contact Bailey Sterrett at bsterrett@aishealth.com.

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 http://www.magnetmail.net/actions/ atlantic_subscription.cfm, where you can also sign up for AIS's Health Business Daily and Spotlight on Health Insurers.

Copyright © 2014 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 rbiehl@aishealth.com.

www.AISHealth.com

 

AIS E-Savings Club Weekly Specials

Upcoming Webinars
Save $50!

Translate 2015 Star Ratings Into Your Plan’s New MA/Part D Strategies
Thurs., Oct. 30, 2014
Click here for details

Public Exchange Enrollment Preview: Insurer Strategies to Sidestep the Pitfalls Ahead
Wed., Nov. 5, 2014
Click here for details

Adopting PBM Formulary Exclusions: Pros and Cons for Health Plans and Purchasers
Thurs., Nov. 13, 2014
Click here for details

What CMS’s 2015 Benchmarks and Landscape Files Mean for MA and Part D Product Planning and Marketing
Tues., Nov. 18, 2014
Click here for details

Missed a Live Event?
Listen at your convenience to recent webinars with On-Demand or CD options!
Private Insurance Exchanges: Bottom-Line Strategies for Insurers
Medicare Advantage News
Mobile Devices in the Workplace: How to Mitigate a Major Patient Privacy/Security Risk