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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.

Federal Government Shutdown Begins, With No Easy Exit In Sight

The federal government started shutting down early Wednesday after Congress failed to approve a funding bill before the beginning of the new fiscal year — resulting in widespread ramifications for hundreds of programs and giving the Trump administration an avenue to fire federal workers en masse.

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Nevada Hospital Wins Half-Billion Fraud Verdict Against Universal Health Services

A jury awarded Saint Mary’s $510 million after United Health Services was found liable for fraud against the longtime Reno healthcare network.

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No Funding Deal In Sight Following High-Stakes White House Negotiations, Party Leaders Say

President Donald Trump and congressional leaders from both parties exited a high-stakes negotiation meeting Monday afternoon with little optimism a deal could be struck before the end of the month to avoid a government shutdown. “I think we’re heading to a shutdown because the Democrats won’t do the right thing,” Vice President J.D. Vance told ...

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Trump Announces Deal With Pfizer To Lower Drug Prices

President Trump on Tuesday announced that Pfizer had agreed to sell its products in the U.S. at “Most Favored Nation” pricing, one day after the administration required companies to respond to his prescription drug pricing executive order. Drugmakers were given until Sept. 29 to respond to Trump’s “Most Favored Nation” Executive Order that required companies ...

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What To Know About Trump’s New Pharmaceutical Tariff Plan

In announcing that branded or patented drugs would be hit with 100 percent tariffs on Oct. 1, Trump also said drugmakers could escape the penalties if they have a U.S.-based pharmaceutical manufacturing plant for which ground has been broken, or is currently under construction.

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As Trump Punts on Medical Debt, Battle Over Patient Protections Moves to States

With the Trump administration scaling back federal efforts to protect Americans from medical bills they can’t pay, advocates for patients and consumers have shifted their work to contain the nation’s medical debt problem to state Capitols. Despite progress in some mostly blue states this year, however, recent setbacks in more conservative legislatures underscore the persistent ...

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California Expands Vaccine Coverage Requirements

On September 17, California Governor Gavin Newsom signed Assembly Bill 144 (AB 144) into law, a move in response to recent changes in immunization recommendations by the U.S. Food and Drug Administration (FDA). The bill, which took effect immediately, mandates that health plans cover a wide range of preventive care services, including immunizations, without cost-sharing or utilization ...

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States Are Cutting Medicaid Provider Payments Long Before Trump Cuts Hit

Every day for nearly 18 years, Alessandra Fabrello has been a medical caregiver for her son, on top of being his mom. “It is almost impossible to explain what it takes to keep a child alive who should be dead,” said Fabrello, whose son, Ysadore Maklakoff, experienced a rare brain condition called acute necrotizing encephalopathy ...

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As the Trump Administration and States Push Health Data Sharing, Familiar Challenges Surface

The Northeast Valley Health Corp. in Los Angeles County could be a poster child for the benefits of sharing health data electronically. Through a data network connecting its records system with other providers, the health center receives not just X-ray and lab results but real-time alerts when hospitals on the network admit or discharge its ...

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AHIP Says Member Plans Will Continue To Cover Vaccines With No Cost-Sharing Through 2026

A major health insurance group reaffirmed that its member plans will uphold current vaccine coverage despite any changes that an influential advisory panel could make to federal recommendations. The pledge to continued vaccine coverage comes ahead of a scheduled meeting Thursday of a federal advisory committee with a slate of new members handpicked by Department of Health ...

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