Federal Regulation news
The True Face of Medicare Fraud
Written by Editor   
Friday, July 03, 2015 03:08 PM
Quick Brief:  A $712 million bust, the biggest in U.S. history, shows that the people most likely to bilk the system are medical doctors and medical providers


A $712 million bust, the biggest in U.S. history, shows that the people most likely to bilk the system are medical doctors and medical providers.  US Attorney General Loretta Lynch’s announced arrests in what she called “the largest criminal healthcare fraud takedown in the history of the Department of Justice.” A total of 243 people were arrested and charged with stealing $712 million from Medicare. The arrests included 46 medical doctors, nurses, pharmacy owners, and other medical professionals.  Medicare’s prescription-drug program is a common target for fraud, it turns out.

 

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Provider Non-discrimination Provision FAQ Update
Written by Editor   
Thursday, June 25, 2015 11:49 AM
Quick Brief: This article contains the language of the new FAQ regarding Section 2706(a) provider non-discrimination.

 

These FAQs have been prepared jointly by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (the Departments').

What is the Departments’ approach to PHS Act section 2706(a)?

In light of the breadth of issues identified in the comments to the RFI, the Departments are re-stating their current enforcement approach to PHS Act section 2706(a). Until further guidance is issued, the Departments will not take any enforcement action against a group health plan, or health insurance issuer offering group or individual coverage, with respect to implementing the requirements of PHS Act section 2706(a) as long as the plan or issuer is using a good faith, reasonable interpretation of the statutory provision, which states:

A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.

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Supreme Court Upholds ACA Subsidies in All States
Written by Editor   
Thursday, June 25, 2015 11:23 AM
Quick Brief:  The Supreme Court has upheld the eligibility for government subsidies for 34 states that did not establish a state marketplace.

 

The Affordable Care Act (ACA) avoided a potential death blow today when the Supreme Court ruled that citizens in 34 states that did not establish their own insurance marketplaces, or exchanges, are eligible for premium subsidies under the 2010 law.

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More Oversight Needed for Vets in Pain
Written by Editor   
Thursday, June 25, 2015 08:11 AM
Quick Brief:  22 veterans per day commit suicide. With a 74% budget increase over the past 6 years, Congress want to know what is being done. "It's not money, it's management."

 

Around 22 veterans commit suicide each day, and Congress wants to know what's being done to save them.

A subcommittee to the House Committee on Veteran Affairs questioned the Department of Veteran's Affairs about the unrelenting tide of soldier suicides and mismanagement of opioid prescriptions. Some representatives suggested the two crises might be intertwined.  "I'm concerned that a potentially deadly mix of opioid use, mental health disorders, and lack of oversight is contributing to our high rate of veteran suicide," said ranking member Ann McLane Kuster (D-N.H.).

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The Supreme Court Is Reshaping American Healthcare
Written by Editor   
Thursday, June 25, 2015 07:55 AM
Quick Brief:  For decades the Supreme Court rarely engaged in major debates over healthcare policy.  Under Chief Justice Roberts, the court will have done more to shape the future of American healthcare than any other in decades. If that doesn't define an activist court, what does?

 

For decades the third branch of government, the Supreme Court, rarely engaged in the major debates over healthcare policy, leaving those decisions to Congress and the Executive Branch.  No more. Under Chief Justice Roberts, this Supreme Court has already done more to drive healthcare policy than any other, at least in my memory.

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