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.
An appeals court affirmed a lower court's ruling that HHS could not force Braidwood and other firms who challenged the ACA mandate to cover PrEP drugs for HIV, however, the nationwide ACA coverage mandate is still in effect.
A federal appeals court in California has shielded a health insurer against a state-law breach-of-contract claims and other state-law claims. A three judge panel at the 9th U.S. Circuit Court of Appeals recently found that the state-law claims had a “connection with” a benefit plan governed by the Employee Retirement Income Security Act. Congress passed ERISA in ...
Sutter Health was absolved this week from a California whistleblower lawsuit alleging the nonprofit system owed $519 million for double-billing patients. After a seven-week trial, Alameda County Superior Court Judge Stephen Kaus ruled Monday retired surgeon Dr. Gregory Duncan and patient Gary Hulbert failed to show that Sutter’s billing practices for surgical patients were fraudulent. Duncan and ...
The US Department of Labor has announced separate settlements with Unum Life Insurance Co. of America and the Lincoln National Life Insurance Co. that relate to their practices on evidence of insurability.
Prescription drug ads will soon look different as new federal transparency rules take effect, requiring commercials to clearly spell out potential side effects, essentially ending those rapid-fire disclaimers at the end of many commercials.
In the wake of the cyberattack on Change Healthcare, a key senator is urging federal regulators to take immediate steps to require major healthcare companies to beef up their cybersecurity. Sen. Ron Wyden, D-Oregon, sent a letter to the Department of Health and Human Services (HHS) on Wednesday saying the agency should immediately issue new ...
Legislators from both sides of the aisle appear to agree that the controversial 340B drug discount program needs refinement rather than upheaval and broadly welcomed suggestions for greater transparency and preserved access to care during a Tuesday oversight hearing.
California’s Office of Health Care Affordability faces a herculean task in its plan to slow runaway health care spending. California is the ninth state to set annual health spending targets.
Five of the suits were filed by Esperion Therapeutics, which seeks to stop competitors from selling generic versions of the company's cholesterol drug Nexletol.
After three years, only a third of 2,000 U.S. hospitals reviewed were in compliance with the Hospital Price Transparency Rule of 2021, says a new PRA report, which puts some of the blame on feds for not enforcing the rule.