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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.

Meta Sued Over Claims Patient Data Secretly Sent to Facebook

Meta Platforms Inc. was sued over claims that private medical data is being shared secretly with Facebook when patients access web portals for some health-care providers. Facebook’s Pixel tracking tool redirects patient communications and other supposedly “secure” information without authorization and in violation of federal and state laws, according to the lawsuit filed Friday in San ...

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Record Budget Surplus Calls for Tripling Down on UI Fund Offset

Californians have traveled a bumpy road to post-pandemic recovery, with healthy employment and wage growth on the one hand, but soaring inflation and cost-of-living increases on the other.

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Preventive Care May Be Free, but Follow-Up Diagnostic Tests Can Bring Big Bills

When Cynthia Johnson learned she would owe $200 out-of-pocket for a diagnostic mammogram in Houston, she almost put off getting the test that told her she had breast cancer.

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American Hospital Association Urges CMS To Extend Enforcement Discretion For No Surprises Act

The American Hospital Association has urged the Centers for Medicare and Medicaid Services to extend enforcement discretion for the No Surprises Act regulatory requirement that healthcare providers exchange certain information to create a good faith estimate for uninsured and self-pay patients – until the agency identifies, and providers can implement, a standard, automated way to exchange the ...

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After Months Of Warnings, CMS Hands Out Its First Fines To Hospitals Failing On Price Transparency

Eighteen months after its final rule on price transparency went into effect, the Centers for Medicare and Medicaid Services issued its first penalties to a pair of Georgia hospitals that did not update their websites or reply to the agency’s warning letters. Northside Hospital Atlanta and Northside Hospital Cherokee have been issued civil monetary penalties ...

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Survey: 13% Of Medicare Advantage Claims, Prior Authorization Requests Denied

A recent survey of Medicare Advantage enrollees found 13% had a claim or pre-authorization request denied as the program has gotten scrutiny over its prior authorization practices. The survey, released Monday by the online insurance marketplace eHealth, also found that 67% of respondents chose MA over Medigap due to concerns over its affordability. The MA ...

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New Drug Prices Soar To $180,000 A Year On 20% Annual Inflation

While gasoline and food prices soar, few products rival the inflation in prices on newly launched prescription drugs, according to a new study.

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The Paw-Ful Truth: These Are The Biggest Pet Claims Of 2021

At the end of 2020, more than 3 million pets were insured in North America. According to the most recent report from the North American Pet Health Insurance Association, that number increased to 4.41 million in 2021. In the United States, there was a 28.3% increase in total pets insured in 2021, with an average ...

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Providers Are Calling For More Time To Implement Estimate Requirement In Surprise Bill Rule

Providers have a little more than six months to find a way to deliver good faith estimates to patients on medical bills, but some say a lack of automated solutions is going to create a colossal burden for them to meet. Several groups have written to the Centers for Medicare & Medicaid Services (CMS) asking ...

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Price Transparency Noncompliance Rampant, Especially In Concentrated Markets, Rural Areas

Hospitals located in more concentrated healthcare markets, rural hospitals and those with higher per patient-day revenue could require “greater scrutiny” to ensure compliance with federal price transparency rules, according to a new analysis. The warning comes alongside yet another review of hospital websites finding low industrywide adherence to the mandate, which requires hospitals to post ...

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