Government News of the Week
Medicare Compliance, HIPAA, Medicare Advantage and Part D,
Health Care Reform, and Other Federal and State Government Developments

March 12, 2012


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(1) A bill that would establish Oregon’s health insurance exchange passed that state’s Senate March 5. Gov. John Kitzhaber (D) signed the bill March 8 .... (more)

(2) A federal appeal court has denied a motion sought by Blue Cross Blue Shield of Michigan to dismiss a lawsuit brought by the Justice Dept. and the state of Michigan over the insurer’s “most-favored nation” contract clauses with hospitals .... (more)

(3) In a new report by HHS on the health reform law’s Pre-Existing Condition Insurance Plan program, perhaps the most telling statistic is that PCIP enrollees’ per-member claims costs in state-based pools are roughly $29,000 per year .... (more)

  Active board involvement in creating and supporting an effective compliance culture clearly is an important goal in the eyes of OIG, but sometimes it seems that boards only get involved when a problem arises. How actively involved in compliance is the board in your health care facility? Join the conversation at the AIS Blogs.

(4) HHS on March 5 issued a report with state-specific data showing the number of people who have benefited from the reform law provision eliminating lifetime limits on health insurance coverage. The department estimated 105 million Americans — including 70 million in large-group plans, 25 million in small-group plans and 10 million with individual coverage — had lifetime limits prior to passage of the reform law, and “now enjoy improved coverage without lifetime limits.” To view the report, click here. The department also released updated state data on the number of Medicare beneficiaries receiving new preventive benefits and the various grant awards made to states. For those data, click here. (Reprinted from AIS’s Health Reform Week's e-News Alert)

(5) Hospice is in the crosshairs of Medicare auditors and enforcers, who are stepping up scrutiny of hospital and freestanding providers. Whether hospice services are vulnerable may depend on the strength of their documentation, including the physician certification, patient election and medical necessity .... (more)

(6) Beth Israel Medical Center agreed on March 1 to pay the federal government more than $13 million to settle allegations that it fraudulently inflated its fees to boost payments from Medicare .... (more)

(7) An Alabama physician on March 1 resolved allegations that he submitted more than $2.2 million in false claims to Medicare .... (more)

(8) A new GAO report identifies research that used varying approaches to estimate cost savings associated with the use of generic drugs in the U.S. ... (more)

(9) A Birmingham, Ala., woman, who pleaded guilty in the theft of records that contained information on more than 4,000 patients from Trinity Medical Center in Birmingham was sentenced to 39 months in a federal prison.... (more)

(10) A physician in Naples, Fla., allegedly accessed 2,300 patient records at NCH Downtown Naples Hospital to offer his medical services to those who did not have a primary care doctor .... (more)

(11) While Republican lawmakers in Washington state have complained exchange progress is proceeding too quickly, the state senate approved changes to its emerging insurance exchange .... (more)



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