Compliance
This section focuses on health care compliance and regulations – both national and state – including the ACA. It includes changes in health care law, regulation, and court decisions and their impact on health insurance professionals, employers, and individuals.
The Trump administration has issued a six-month moratorium on hospice and home health agencies enrolling in Medicare as part of its efforts to combat fraud. The Centers for Medicare & Medicaid Services said in an announcement on Wednesday morning that the “data-driven” decision targets a key source of fraud activity. It follows a similar announcement ...
In April, the Centers for Medicare & Medicaid Services began enforcing the strongest hospital price transparency rules in the program’s history. The Calendar Year 2026 Outpatient Prospective Payment System final rule eliminates the “estimated allowed amount” placeholder that hospitals used to game disclosure, requires three new data elements based on 12 to 15 months of actual claims ...
State Obamacare marketplaces are starting to feel tremors from the GOP-controlled Congress’s ending of enhanced subsidies, as millions of Americans are dropping coverage. Experts and state officials say the impact varies from state to state, but enrollment decline is expected to grow this year and beyond, as policies from the One Big Beautiful Bill Act and potential Trump ...
A new task force will investigate healthcare fraud cases in Nevada, Arizona and part of California, the Justice Department announced Thursday. The West Coast Health Care Fraud Strike Force will combine resources from DOJ’s National Fraud Enforcement Division, and its the Health Care Fraud Section, with U.S. attorney’s offices in Nevada, Arizona and the Northern ...
Fighting for health care claim approvals 05:19 UnitedHealthcare said on Tuesday it is eliminating “prior authorization” requirements for 30% of medical services that previously required insurer approval, a policy shift that could eliminate red tape and speed access to patient care. The move comes amid pressure on the health insurance industry to limit prior authorizations, ...
State officials remain uncertain on how to enforce a requirement that many adult Medicaid enrollees show they’re working — even as one state launches its program this week — and they’re taking a variety of approaches to the job, including, in a handful of states, using artificial intelligence. A KFF survey of Medicaid officials from 42 states and the ...
Supreme Court justices on Wednesday heard oral arguments over a drug approval pathway that could have implications for the availability of cheaper generic medicines. The case, Hikma v. Amarin, centers on “skinny labeling,” a process that allows generic drugs to come to market faster. Under the skinny labeling pathway, the Food and Drug Administration allows ...
The Federal Trade Commission has filed suit to intervene in a scheme in which it says fraudulent telemarketers targeted individuals seeking insurance coverage. Per the complaint (PDF), which was filed earlier this month, the FTC alleges that participants in the scheme—who operated under names like American Collective and Innovative Partners—would contact consumers and tell them that they ...
Last summer, the insurance industry broadly agreed to reform a major healthcare pain point: prior authorization. Now, two of the industry’s leading organizations are offering a look at progress toward those goals. AHIP and the Blue Cross Blue Shield Association released a report on Tuesday that found leading health plans reduced prior authorizations for an array of ...
The Trump administration unveiled a new program to speed up Medicare coverage for breakthrough devices, touting that the new pathway cuts red tape for medical device companies to gain reimbursement. The Centers for Medicare and Medicaid Services (CMS) and the U.S. Food and Drug Administration (FDA) announced on Thursday the Regulatory Alignment for Predictable and ...