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.
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 ...
Generic drug maker Glenmark has agreed to a settlement with states worth $29.6 million, according to a Wednesday announcement from the Nevada Attorney General. The settlement will be split among 47 states, and a $13 million consumer restitution fund will be created. A news release indicated impacted Nevada agencies will get about $41,000. Glenmark’s settlement ...
Attorney General Aaron Ford, criticized by Gov. Joe Lombardo and one of the governor’s legislative allies for acting on only 40% of Medicaid fraud referrals sent to his office, is taking on twice the share of cases as the average of all states, according to federal data. First-term Republican Assemblyman Blayne Osborn wrote the Nevada ...
The federal watchdog for the Department of Health and Human Services (HHS) generated $5.56 billion in expected recoveries and projected savings over a six-month period, according to a report issued Monday, and it barred just more than 1,200 individuals and companies from federal programs. The HHS Office of Inspector General (OIG), in a semiannual report to ...
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 ...