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.
Americans who fill prescriptions through Canadian and other international mail-order pharmacies have about three weeks before a federal customs rule reaches its compliance deadline on October 22, and a growing number of members of Congress are urging the Trump administration to reconsider it. The rule, issued by U.S. Customs and Border Protection (CBP), does not ...
The Trump administration plans to cancel enrollment in Affordable Care Act plans for more than 760,000 people as part of its crackdown on fraud, waste and abuse. The Centers for Medicare & Medicaid Services announced on Tuesday that it would cancel 315,000 “unauthorized enrollments” covering that population, a move the agency said will return $2.2 ...
One thing was true for most employees in previous generations – although their job may not always have paid well, it did pay every two weeks. Far more Americans today work as contractors, freelancers and gig or temporary workers, or are self-employed, run small businesses or have multiple part-time jobs. Along with making their income ...
The Centers for Medicare and Medicaid Services is making it easier for Medicare Advantage insurers to swoop in and rescue struggling rivals. The agency last week notified insurance companies that it may allow them to expand where they sell policies midyear if they acquire competitors. Previously, CMS only considered expansion requests during the annual bid ...
The expanding role of artificial intelligence in medical care in the United States has raised concerns, even as the Trump administration said it is taking a "responsible, evidence-based approach" that maintains safeguards for patients.
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 ...