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.
Leading Republicans are looking toward the Government Accountability Office (GAO) to ensure CMS’ new premium stabilization demonstration program is legal and in the best interest of seniors. In a recent letter written by House Energy and Commerce Committee Chair Cathy McMorris Rodgers, R-WA, Senate Finance Committee Ranking Member Mike Crapo, R-ID, and House Ways and ...
The Fifth Circuit Court's ruling, which was filed late last week, confirms a February 2023 decision from the court in the Eastern District of Texas, vacating arbitration methodology set by the Centers for Medicare & Medicaid Services (CMS).
Consumers who try to buy popular weight loss drugs online without a prescription risk being scammed or receiving unsafe products, a new study shows. About 42% of online pharmacies that sell semaglutide, the active ingredient in Novo Nordisk’s anti-obesity drug Wegovy, are illegal, operating without a valid license and selling medications without prescriptions, according to a ...
The Centers for Medicare & Medicaid Services (CMS) is creating a voluntary demonstration program to support changes to Medicare Part D under the Inflation Reduction Act (IRA). The agency also finalized bid information for contract year 2025, with a base beneficiary premium increase of $2.08 for people with Part D. The IRA is designed to ...
A preliminary injunction, granted Thursday by a federal judge, puts the implementation of the Labor Department's controversial new Retirement Security Rule, set to take effect September 23, on hold until further order of the court.
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.