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!

February 23, 2015

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(1) CMS on Feb. 20 said it is allowing for a special enrollment period for individuals and families who did not possess health insurance in 2014 and are subject to a fine when they file their 2014 taxes in states using federally facilitated exchanges (FFEs) .... (more)

(2) Humana Inc. on Feb. 18 told the Securities and Exchange Commission (SEC) in a 10-K filing that the Department of Justice (DOJ) is investigating the insurer’s Medicare Advantage (MA) billing practices .... (more)

  From the AIS Blogs
  Other than that “there are lies, damn lies and statistics,” what do you think are the biggest takeaways from CMS’s February MA enrollment data? Join the conversation at the AIS Blogs.

(3) Compassionate Care Hospice of New York, LLC and Compassionate Care Hospice Group Ltd. agreed to pay $4.99 million to the federal government and $1.68 million to New York state to settle false claims allegations, the U.S. Attorney for the Southern District of New York said on Feb. 18 .... (more)

(4) The home infusion industry is hoping that the fifth time’s the charm for bills recently proposed in the U.S. Senate and the House that seek to offer comprehensive Medicare coverage for home infusion .... (more)

  From Congress and the Federal Agencies

(5) The IRS on Feb. 18 offered new guidance to small employers (fewer than 50 employees) that, among other actions, waives a $100 per-day, per-employee penalty for those businesses providing coverage under which they reimburse workers for individual premiums in stand-alone health reimbursement arrangements (HRAs) .... (more)

(6) Deep inside its annual 10-K report filed to the Securities and Exchange Commission (SEC), UnitedHealth Group said two class-action lawsuits remain active in the case of a hepatitis C outbreak at a Nevada endoscopy center that was a provider in its Health Plan of Nevada, Inc. subsidiary’s network .... (more)

(7) The HHS Office of Inspector General said billing for services provided by a medical practice before the physician was excluded from Medicare and other federal health programs for 20 years would not violate the terms of the exclusion or trigger civil monetary penalties .... (more)

(8) HHS last month asked a district court judge to dismiss the most recent lawsuit (Pharmaceutical Research and Manufacturers of America v. United States Department of Health and Human Services, Civil Action No. 1:14-cv-01685-RC) over the 340B discount drug program, which PhRMA brought against it in early October .... (more)

(9) One of the four plaintiffs in the King v. Burwell case before the Supreme Court that could scuttle subsidies for enrollees on federally run public exchanges, and possibly crash the Affordable Care Act, listed her address as a short-term-stay motel when she joined the suit .... (more)

(10) U.S. Sens. Chuck Grassley (R-Iowa), Deb Fischer (R-Neb.) and Joni Ernst (R-Iowa) on Feb. 9 wrote a letter to CMS Administrator Marilyn Tavenner asking her to clarify whether the agency will reimburse the more than 100,000 members of the failed CoOportunity Health. The nation's second largest CO-OP is being liquidated by Insurance Commissioner Nick Gerhart, after unexpectedly high-risk enrollment and a loss of CMS funding through the risk-corridor program forced it under. (From Inside Health Insurance Exchanges' E-Alert)

(11) Pennsylvania Gov. Tom Wolf (D) on Feb. 10 decided to ditch his predecessor’s Healthy PA Medicaid expansion effort and go instead with the state’s traditional Medicaid expansion program under the ACA .... (more)

(12) Thirteen percent of Medicaid enrollees also had some form of private insurance in 2012 .... (more)


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