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!

May 2, 2016

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(1) New York Attorney General Eric Schneiderman (D) on April 26 said seven health insurers have agreed to revise their coverage policies for chronic Hepatitis C treatment following his office’s investigation into how carriers decided such coverage policies .... (more)

(2) California physician Gary J. Ordog pleaded guilty on April 28 to health care fraud in connection with his submission of $2.4 million in fraudulent Medicare claims .... (more)

  From the AIS Blogs
  While they may not fall under the HIPAA umbrella (yet), the privacy of biometric and other health data captured by the influx of new apps and wearable gadgets is a source of concern among consumers and regulators alike. The question is what will lawmakers and regulators deem "protected" data, and will the shift to consumerism prompt them to do away with arcane technicalities like covered entities and business associates? Join the conversation at the AIS Blogs.

(3) Republican leaders of the House Subcommittee on Oversight and Investigations on April 15 blasted the Obama administration for having “cozy” ties to health insurers. The accusations came during a hearing that called reinsurance payments for Qualified Health Plans on public exchanges under the Affordable Care Act (ACA) an unlawful diversion of $3.5 billion from taxpayers to insurers. Rep. Tim Murphy (R-Pa.) said reinsurance payments were a bailout, which could be further threatened if ACA exchanges fail. CMS Acting Administrator Andy Slavitt, testifying at the hearing, said the decision to aid insurers through the reinsurance program came after thorough review and proper rulemaking .... (From Inside Health Insurance Exchanges' E-Alert)

(4) Seemingly in response to UnitedHealth Group’s intended 2017 exit from most of the 34 Affordable Care Act exchanges where it currently sells coverage, CMS on April 21 issued a draft notice clarifying that insurers cannot automatically enroll former exchange members in off-exchange plans after leaving the marketplaces .... (more)

  From Congress and the Federal Agencies

(5) CMS’s enhanced enrollment screening tools have had mixed success in keeping out undesirable providers, according to a new report from the HHS Office of Inspector General .... (more)

(6) CMS on April 18 extended parts of its Bundled Payments for Care Improvement (BPCI) initiative through Sept. 30, 2018 .... (more)

(7) A Tuscola County Circuit Court judge in Michigan sentenced a man to prison for bilking Blue Cross Blue Shield of Michigan out of $1.7 million .... (more)

(8) A physical therapy practice in Vero Beach, Fla., was overpaid $52,515, according to an OIG audit, which sounded very much like a Medicare compliance review .... (more)


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