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.
Major reforms were finalized today to strengthen the No Surprises Act by making the Federal Independent Dispute Resolution (IDR) process more efficient and transparent, while also saving money for millions of Americans. The final rule improves the process used to resolve out-of-network payment disputes between providers and payers—cutting administrative costs and improving how disputes are ...
The Trump administration recently finalized a major regulation governing the Affordable Care Act’s marketplaces, and community health plans are raising concerns about the impact the changes could have on consumers. Heather Foster, vice president for marketplace policy at the Association for Community Affiliated Plans (ACAP), told Fierce Healthcare in an interview that one of the biggest challenges ...
Several academic and nonprofit health systems have filed lawsuits against CVS Health, accusing the company and its subsidiaries of improperly pocketing about $250 million of 340B Drug Pricing Program savings from 2020 to 2025. The providers’ legal complaints were filed earlier this week in New York, Kansas and Michigan federal courts. Among the plaintiffs are ...
At a White House event, Vance said the Centers for Medicare & Medicaid Services would withhold $1.3 billion in Medicaid funding from the state of California, as officials have "not taken fraud very seriously."
A $25 million grant to cash-strapped hospitals became law less than a week after it was introduced — so fast that it caught some hospitals, their advocates, and even some lawmakers, off guard. It also left a litany of unanswered questions: who came up with the narrow criteria, how many hospitals would qualify and whether ...
Physicians remain skeptical that health insurers’ pledges to ease prior authorization hassles will result in any meaningful action, an American Medical Association (AMA) survey found. In June 2025, a group of about 60 insurers said that they would standardize electronic prior authorization by the end of 2026 to help speed up the process. They also said they would reduce ...
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 ...