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.
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 ...
The Blue Cross Blue Shield Association submitted a wide-ranging letter to CMS on March 30 in response to the agency’s information request on its Comprehensive Regulations to Uncover Suspicious Healthcare, or CRUSH, initiative. Seven BCBSA recommendations: 1. CMS should notify Medicare Advantage plans in real time when it suspends payments to a provider over suspected ...
The Trump administration is preparing to impose new tariffs on branded drugs from pharmaceutical companies that have not struck landmark deals with the president to lower their U.S. drug prices, CNBC has learned. Patented medications and their active ingredients would be hit with a 100% tariff, according to a draft of the document obtained by ...
Mark Cuban, owner of Cost Plus Drugs and a longtime critic of the pharmaceutical industry, is speaking out in support of the congressional Break Up Big Medicine Act. “I don’t think people realize how much health care costs are driving big companies to fire and not hire,” he wrote in a social media post. “It ...
CVS Health subsidiary Aetna, Elevance Health and Humana must face a civil lawsuit alleging they paid kickbacks to online brokerages for Medicare Advantage enrollments, a federal court ruled Wednesday. A whistleblower initiated the case in 2021, which the U.S. District Court for the District of Massachusetts unsealed last year after the Justice Department intervened. According to the ...