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.
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 ...
Dive Brief: A federal judge has struck down key provisions in a CMS rule overhauling the Affordable Care Act, in a setback for the Trump administration’s push to combat fraud that critics argue is a smokescreen for weakening the exchanges set up by the Obama-era law. On Friday, Judge Brendan Hurson of the Maryland District Court vacated ...
The Affordable Care Act seems to always be in a policy tug-of-war as its backers and critics spar over how it should work and who can qualify for coverage. This year is no different, with the Trump administration embracing standards it says will reduce fraud as well as steps that could further erode national enrollment. ...
The Trump administration has warned more than 500 hospitals that they are failing to provide the public with basic pricing information — arguing that the lack of disclosure is keeping healthcare costs higher than they should be. The Associated Press obtained exclusively the list of hospitals that since April have either received letters of warning or, in more severe ...
A Trump administration initiative to impose $100,000 fees on employers seeking visas for skilled foreign workers amounts to an unlawful tax on those companies and must be voided “in its entirety,” a federal judge ruled on Monday. The decision by Judge Leo T. Sorokin of the Federal District Court for the District of Massachusetts nullified ...