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.
President Donald Trump on Tuesday afternoon signed a massive funding package that ends a brief government shutdown and provides full-year funding for the federal government through the end of the year. The House voted earlier in the day to pass the package by a vote of 217-214. As part of negotiations between Senate Democrats and ...
The Federal Trade Commission and Cigna’s Evernorth unit have officially reached a settlement that resolves allegations that the company’s pharmacy benefit manager artificially drove up prices for insulin. As part of the settlement, Evernorth’s Express Scripts has agreed to several key business changes that are designed to reduce insulin prices significantly, the FTC said in ...
Pharmacies may have a better chance to win racketeering lawsuits against other insulin supply-chain players than health plans or patients do. U.S. District Judge Brian Martinotti recently issued two rulings that let pharmacies, or “direct purchaser” plaintiffs, move ahead with claims against pharmacy benefit managers that were based on the federal Racketeer Influenced and Corrupt ...
Hospital leaders are getting long-awaited clarity from Congress this week as lawmakers unveil a bipartisan healthcare deal tied to a broader government funding package. The 771-page proposal includes major wins for providers, including a multiyear delay of Medicaid DSH cuts, key Medicare payment extensions for rural hospitals and permanent hospital-at-home authority. It also preserves pandemic-era telehealth flexibilities ...
A lack of Democratic cooperation and strict Senate rules threaten the legislative viability of the White House framework.
While the conversation at the House E&C Subcommittee hearing this morning was fairly varied, in the early questioning before the Ways and Means Committee, the debate over the Affordable Care Act has been front and center. Ranking Member Richard Neal, D-Massachusetts, said in his opening remarks that the expiry of the enhanced subsidies in the ...
President Donald Trump has hinted at “concepts of a plan” for healthcare for months as legislators debate the future of key subsidies under the Affordable Care Act, and on Thursday the White House unveiled a more concrete version of its vision for health policy. Called “The Great Healthcare Plan,” Trump’s proposal would send the value ...
Several medical organizations have asked a judge to declare the U.S. Centers for Disease Control and Prevention’s decision this month to narrow the list of vaccines recommended for children unlawful, calling the move “egregious, reckless, and dangerous.” The American Academy of Pediatrics and a coalition of other medical groups on Monday moved to expand a lawsuit, ...
Anthem Blue Cross accused 11 Prime Healthcare hospitals of fraud in a lawsuit filed this week in a California federal court. The defendants submitted and were compensated for thousands of claims for independent dispute resolution under the No Surprises Act despite knowing they were false, the insurer alleged. “We are holding billing companies and out-of-network ...
Members of the U.S. House today voted 221-205 to bring an Affordable Care Act health insurance premium subsidy bill resolution up on the House floor, against the wishes of Republican House leaders. The resolution could lead to floor consideration of an ACA premium subsidy bill. The underlying bill could keep the high ACA premium subsidy ...