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!

March 30, 2015

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(1) A long list of program-integrity provisions were tucked into the 2015 Medicare Access and CHIP Reauthorization Act (H.R. 2), which was passed by the House of Representatives on March 26 and has a good chance of becoming law in April .... (more)

(2) News surfaced on March 17 that not-for-profit Blue Shield of California lost its tax-exempt status in August 2014 .... (more)

  From the AIS Blogs
  With the approval of the first U.S. biosimilar through the Biologics Price Competition and Innovation Act and others to follow, it’s an exciting time in pharmacy benefit management. But biosimilars — like several other marketplace dynamics — are rife with unknowns. Learn about them at the AIS Blogs.

(3) The New York Attorney General’s office said March 18 that it reached a settlement with Rochester, N.Y.-based Excellus Health Plan after an AG investigation determined the Blues plan operator had wrongfully denied treatment requests for mental health and addiction services .... (more)

(4) UnitedHealth Group unit UnitedHealthcare Insurance Co. on March 19 filed suit in Los Angeles Superior Court to stop HCA Holdings Inc. from allegedly planning to reveal confidential reimbursement .... (more)

  From Congress and the Federal Agencies

(5) The Medicaid expansion resulted in a savings of $7.4 billion in uncompensated care for hospitals .... (more)

(6) At Congress’ behest, CMS is cracking down on Medicare payments to long-term care hospitals (LTCH). A forthcoming regulation will address payments under the LTCH prospective  .... (more)

(7) Humana Inc. disclosed in a March 23 regulatory filing that the Dept. of Justice (DOJ) is expanding its investigation into the insurer’s risk adjustment practices in its Medicare Advantage (MA) plans .... (more)

(8) Federal authorities have charged a former Blue Cross Blue Shield of Michigan (BCBSM) customer service representative and 10 alleged co-conspirators with fraud after busting an identity theft ring that spanned several states and racked up hundreds of thousands of dollars in fraudulent charges .... (more)

(9) The number of uninsured Americans has reached its lowest level in more than 15 years, dropping by more than 11 million since the Affordable Care Act was enacted five years ago, according to a report released March 24 by the Centers for Disease Control. However, about 37 million people remain uninsured. The advance premium tax credit (APTC), which helps reduce the cost of insurance coverage for low-income people, likely contributed to more people becoming insured in 2014, according to a separate study released the same day by the Government Accountability Office. Uninsured rates “declined significantly among households with incomes eligible for the APTC,” according to the report. The nonpartisan report found that subsidies expanded coverage among uninsured individuals by as much as 5% in 2014. In addition, they helped reduce premiums by 76% between 2013 and 2014.(From Inside Health Insurance Exchanges' E-Alert)

(10) The Government Accountability Office (GAO) on March 23 attributed the reduction in the number of the uninsured to the advance premium tax credits offered through the health insurance .... (more)

(11) A Detroit-area physician pleaded guilty for his role in a home health kickback scheme .... (more)

(12) Portage Hospital in Hancock, Mich., agreed to pay $4.4 million to settle false claims allegations stemming from home health claims submitted by a hospital-owned home health agency .... (more)

(13) Medicare Advantage total enrollment rose by 32,025 lives from the previous month to 16,366,528, according to data released by CMS March 9 for the March 1 payment date .... (more)

(14) Sens. Pat Roberts (R-Kan.) and Jeanne Shaheen (D-N.H.) on March 18 introduced a bill aimed at improving seniors’ access to medication therapy management (MTM) services .... (more)


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