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.
Lawmakers bashed the business practices of pharmacy benefit managers during a House Committee on Oversight and Accountability hearing Tuesday. When they were asked repeatedly about steering patients, increased drug prices and pharmacy closures, the company executives largely refuted claims thrown at them. Lawmakers were overwhelmingly frustrated with the perceived non-answers given and at one point reminded the ...
The Centers for Medicare & Medicaid Services (CMS) has released new data on risk adjustment payments for 2023. The agency said (PDF) insurers participating on the Affordable Care Act’s exchanges will pay $10.3 billion as part of the risk adjustment program. Risk adjustment state transfers as a percent of premiums declined from 2022, according to the report. ...
The IRS issued its highly anticipated final regulations for required minimum distributions on July 19, 2024. These regulations incorporate rules from both the Secure and Secure 2.0 acts.
The CrowdStrike internet meltdown that wrecked havoc with some health systems’ procedures and billing on Friday could be a harbinger of future threats and disruptions to medical facilities, experts said. Why it matters: The U.S. health system is still dealing with fallout from the massive Change Healthcare ransomware attack and other incidents that have underscored the sector’s reliance on a few key ...
Just one day after issuing a report blasting pharmacy benefit managers for their business practices and focus on consolidation and vertical integration, the Federal Trade Commission (FTC) is reportedly suing CVS Caremark, Express Scripts and OptumRx for directing patients toward more expensive drugs.
Healthcare legal observers are still reacting to the Supreme Court’s recent decision to gut the Chevron doctrine, fundamentally altering the power federal agencies have to handle regulations as they find appropriate. While the aftermath of the decision will likely play out in the months and years to come, many are keeping an eye out for ...
California Attorney General Rob Bonta has led 21 attorneys general in filing an amicus brief in the case of Pharmaceutical Research & Manufacturers of America v. Stolfi, advocating for laws that enhance drug price transparency. The brief, submitted to the Ninth Circuit Court of Appeals, supports Oregon’s House Bill 4005, which mandates pharmaceutical manufacturers to ...
The Biden administration is proposing a 2.8% decrease to physician payments in its newly released pay proposal for physicians, drawing near-immediate protest from the industry. Unveiled Wednesday afternoon, the calendar year 2025 Medicare Physician Fee Schedule proposed rule outlines new policies focused on primary care, preserved telehealth flexibilities and a strengthened Medicare Shared Savings Program ...
A proposed rule that would require the nation's most critical industries to more quickly report cyberattacks is raising the ire of the health care industry, which claims the new directives could actually hinder its response in a crisis.
Private insurance firms running Medicare Advantage programs have been overcharging the federal government billions of dollars by making patients look sicker than they really are, according to a report in The Wall Street Journal on Monday.