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 Federal Trade Commission has filed suit to intervene in a scheme in which it says fraudulent telemarketers targeted individuals seeking insurance coverage. Per the complaint (PDF), which was filed earlier this month, the FTC alleges that participants in the scheme—who operated under names like American Collective and Innovative Partners—would contact consumers and tell them that they ...
Last summer, the insurance industry broadly agreed to reform a major healthcare pain point: prior authorization. Now, two of the industry’s leading organizations are offering a look at progress toward those goals. AHIP and the Blue Cross Blue Shield Association released a report on Tuesday that found leading health plans reduced prior authorizations for an array of ...
The Trump administration unveiled a new program to speed up Medicare coverage for breakthrough devices, touting that the new pathway cuts red tape for medical device companies to gain reimbursement. The Centers for Medicare and Medicaid Services (CMS) and the U.S. Food and Drug Administration (FDA) announced on Thursday the Regulatory Alignment for Predictable and ...
Officials have failed to halt pervasive fraud in the hospice industry despite promises of reforms five years ago after learning of widespread corruption that targeted vulnerable patients. California authorities promised to crack down after a Times investigation in late 2020 revealed that a cohort of mostly older Americans was being targeted by unscrupulous providers who ...
Hospital and pharma groups have sharpened their spears for the rematch on 340B rebates. In comment letters submitted just ahead of a Monday deadline, the stakeholders weighed in on a contentious Trump administration pilot program that would overhaul drug discounts hospitals have received for the past 30 years to subsidize safety-net care. Rather than receive ...
UnitedHealthcare said it’s going to eliminate most requirements for prior authorization for medical care for about 1,500 rural hospitals and their affiliated health care providers by this fall. The change will affect all of the small, isolated rural hospitals classified as “critical access hospitals.” In January, the United States had 1,381 critical access hospitals, according ...
In his first appearance on Capitol Hill this year, Health Secretary Robert F. Kennedy Jr. defended his record in running the Department of Health and Human Services. On Thursday, Kennedy testified before the House Ways and Means Committee, playing up his agency’s accomplishments on a range of issues — from drug price negotiations to the ...
The National Association of Benefits and Insurance Professionals (NABIP) today announced significant policy victories for agents, brokers, and the millions of Medicare beneficiaries they serve following the release of CMS’s Contract year 2027 Medicare Advantage and Part D Final Rule. The final rule reflects a strong alignment with NABIP’s advocacy to modernize Medicare marketing and ...
California officials last Thursday said they uncovered a multimillion-dollar scheme to use stolen identities from people outside the state to charge for hospice services paid for with a government insurance program.
The Trump administration’s bid to rewrite how catastrophic plans are structured under the Affordable Care Act is raising legal and actuarial questions, even as some policy professionals applaud the creativity aimed at solving rising premiums. The Centers for Medicare & Medicaid Services released a proposed rule earlier this year that would allow catastrophic plans to design terms ...