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.
Overview Health Net is exiting the California Small Group and Large Group medical markets. The exit impacts all Health Net Small Group and Large Group medical groups, including groups enrolled through CalChoice. This change does not impact the Medi-Cal, Marketplace/Covered California or Medicare lines of business. The final Health Net renewal and new-business effective date is September ...
New penalties can fine hospitals and insurers up to 125% of their overspending, with enforcement starting as early as 2028. Hospital executives argue much of their spending, like drug costs and labor, is outside their control.
An international crime ring helps Americans get licensed as insurance agents or brokers, then uses the new producers’ credentials to bilk health insurers and the federal government. Officials at the Iowa Division of Insurance put out a warning about the new enrollment fraud strategy Tuesday. The criminals start by contacting job hunters or other would-be insurance producers. ...
Three employer groups are asking the 9th U.S. Circuit Court of Appeals to let the insurers and employers involved in No Surprises Act claim disputes sue over what they believe to be outrageous awards. The groups — the American Benefits Council, the ERISA Industry Committee and the Business Group on Health — are urging the appeals ...
California is not changing its childhood vaccination recommendations, or its requirement to have health insurers cover the inoculations, after President Donald Trump’s executive order that calls for reducing the number of vaccines U.S. children receive, state health officials say. The executive order, signed this week, calls for scaling back the number of routine childhood vaccinations, splitting the MMR ...
A quiet change in California law in 2018 unleashed a deluge of new hospices and spurred millions of dollars in Medicare fraud that state and federal authorities are still trying to unwind. Hospices shared addresses with burrito stands, car repair shops and vacant lots. They piled into nondescript office buildings offering cheap rent, month-to-month leases ...
A health care advocacy group on Thursday sued the American Medical Association in an effort to get more transparency over the association’s billing codes, which guide billions of dollars in health care payments. PatientRightsAdvocate.org hopes to republish the codes online and allow the public to search them free. The group, which has pushed for health care ...
Democratic attorneys general are making a renewed push to challenge the latest regulation governing the Affordable Care Act’s marketplaces. In a lawsuit filed Friday, the AGs of 21 states, as well as Pennsylvania Gov. Josh Shapiro, argue that the rule, which establishes key policies for the 2027 plan year, will make ACA plans more expensive ...
The No Surprises Act’s arbitration process awarded close to $15 billion to providers in 2025, according to a Wall Street Journal analysis of federal data. Payouts through the independent dispute resolution process reached $14.85 billion in 2025, up from just $4.08 billion in 2024, the Journal reported. Arbitration firms collected about $1.3 billion in fees last year. “This law ...
Figuring out who’s offering the best deal on heart surgeries or routine physicals isn’t the most pressing issue for everyday Americans. That hasn’t stopped lawmakers on Capitol Hill from trying to turn that kind of price transparency into their marquee bipartisan health care goal this year. Republican and Democratic lawmakers who advanced bills on the ...