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.
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."
A $25 million grant to cash-strapped hospitals became law less than a week after it was introduced — so fast that it caught some hospitals, their advocates, and even some lawmakers, off guard. It also left a litany of unanswered questions: who came up with the narrow criteria, how many hospitals would qualify and whether ...
Physicians remain skeptical that health insurers’ pledges to ease prior authorization hassles will result in any meaningful action, an American Medical Association (AMA) survey found. In June 2025, a group of about 60 insurers said that they would standardize electronic prior authorization by the end of 2026 to help speed up the process. They also said they would reduce ...
The Trump administration has issued a six-month moratorium on hospice and home health agencies enrolling in Medicare as part of its efforts to combat fraud. The Centers for Medicare & Medicaid Services said in an announcement on Wednesday morning that the “data-driven” decision targets a key source of fraud activity. It follows a similar announcement ...
In April, the Centers for Medicare & Medicaid Services began enforcing the strongest hospital price transparency rules in the program’s history. The Calendar Year 2026 Outpatient Prospective Payment System final rule eliminates the “estimated allowed amount” placeholder that hospitals used to game disclosure, requires three new data elements based on 12 to 15 months of actual claims ...
State Obamacare marketplaces are starting to feel tremors from the GOP-controlled Congress’s ending of enhanced subsidies, as millions of Americans are dropping coverage. Experts and state officials say the impact varies from state to state, but enrollment decline is expected to grow this year and beyond, as policies from the One Big Beautiful Bill Act and potential Trump ...
A new task force will investigate healthcare fraud cases in Nevada, Arizona and part of California, the Justice Department announced Thursday. The West Coast Health Care Fraud Strike Force will combine resources from DOJ’s National Fraud Enforcement Division, and its the Health Care Fraud Section, with U.S. attorney’s offices in Nevada, Arizona and the Northern ...
Fighting for health care claim approvals 05:19 UnitedHealthcare said on Tuesday it is eliminating “prior authorization” requirements for 30% of medical services that previously required insurer approval, a policy shift that could eliminate red tape and speed access to patient care. The move comes amid pressure on the health insurance industry to limit prior authorizations, ...
State officials remain uncertain on how to enforce a requirement that many adult Medicaid enrollees show they’re working — even as one state launches its program this week — and they’re taking a variety of approaches to the job, including, in a handful of states, using artificial intelligence. A KFF survey of Medicaid officials from 42 states and the ...
Supreme Court justices on Wednesday heard oral arguments over a drug approval pathway that could have implications for the availability of cheaper generic medicines. The case, Hikma v. Amarin, centers on “skinny labeling,” a process that allows generic drugs to come to market faster. Under the skinny labeling pathway, the Food and Drug Administration allows ...