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.
CMS Mulls Tougher Medicare Enrollment Rules To Combat Fraud As Part Of 2027 Home Health Payment Rule
The Centers for Medicare and Medicaid Services released on Wednesday afternoon its 2027 proposed payment rule for home health agencies. The rule includes an aggregate payment increase of $420 million, or 2.4%, based on a proposed 2.1% payment update and an estimated 0.3% increase related to the fixed dollar loss ratio. That 2.1% payment update ...
Dive Brief: A federal judge has struck down key provisions in a CMS rule overhauling the Affordable Care Act, in a setback for the Trump administration’s push to combat fraud that critics argue is a smokescreen for weakening the exchanges set up by the Obama-era law. On Friday, Judge Brendan Hurson of the Maryland District Court vacated ...
The Affordable Care Act seems to always be in a policy tug-of-war as its backers and critics spar over how it should work and who can qualify for coverage. This year is no different, with the Trump administration embracing standards it says will reduce fraud as well as steps that could further erode national enrollment. ...
The Trump administration has warned more than 500 hospitals that they are failing to provide the public with basic pricing information — arguing that the lack of disclosure is keeping healthcare costs higher than they should be. The Associated Press obtained exclusively the list of hospitals that since April have either received letters of warning or, in more severe ...
A Trump administration initiative to impose $100,000 fees on employers seeking visas for skilled foreign workers amounts to an unlawful tax on those companies and must be voided “in its entirety,” a federal judge ruled on Monday. The decision by Judge Leo T. Sorokin of the Federal District Court for the District of Massachusetts nullified ...
A Department of Labor proposal to raise the pay scale of foreign workers has triggered warnings of new and potentially unsustainable strain on healthcare employers. The policy was proposed in late March and was open to public comment through last week. It proposes a methodology change for wage minimums that are applied to those with ...
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."