HIPAA Security Breaches: 10 Steps to Take When a Breach Occurs; Mental Health Parity: How to Comply With New Final Regs; Accountable Care Organizations: Strategies That Health Plans Should Implement Now - audioconferences


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Government News
of the Week:


Medicare Compliance, HIPAA, Medicare Advantage and Part D, and Other Federal and
State Government Developments


 
Recent Issues
Jan. 18

Feb. 8, 2010

(1) A bill to strengthen federal oversight of prescription drug benefits for the Federal Employees Health Benefits Program would impose strict new regulations on PBMs and health plans, such as mandating disclosure of sensitive pricing information and requiring physician permission for drug switching....(more)

(2) House Speaker Nancy Pelosi (D-Calif.) said she plans to bring to a vote soon a stand-alone bill aimed at ending the health insurance industry’s half-century-old exemption from antitrust laws, according to various news sources....(more)

2000-2009 Survey Results: Pharmacy Benefit Trends & Data
This book and CD features the results — plus analyses — of AIS’s quarterly PBM surveys, from 2000 to 2nd quarter of 2009. It contains hundreds of charts, tables and graphs on costs, benefit design, utilization and PBM market share, plus a directory of PBMs, PBAs, and SPPs. Click here.


(3) A Boulder County, Colo., jury ruled that a subsidiary of Assurant Health must pay $37.3 million to a woman whose policy was canceled after a serious car accident, according to the plaintiff’s attorney Marc Levy.....(more)

(4) Given the uncertain future of a final health reform bill, the spotlight has returned to state efforts, many of which were underway before President Obama took office, and long before Senate Democrats lost their filibuster-proof majority. But industry observers contacted by AIS say most states are so strapped for cash that any efforts to expand insurance coverage — or enact other changes — will be difficult....(more)

Key Financial Indicators for Leading Health Plans
Get financial data points for 50 leading health plans, including: premium revenue, hospital/medical costs, pharmacy costs, administrative costs and more. Click here for details.

(5) The HHS budget submitted as part of President Obama’s Fiscal Year 2011 spending plan includes significant investments to escalate the assault on fraud and abuse, with a $1.7 billion total for HHS fraud-fighting efforts that includes a $60.2 million increase for HHS-DOJ strike force initiatives....(more)

(6) New York Gov. David Paterson (D) introduced a bill that would set up a code of conduct for interactions between health care professionals and pharmaceutical, biologic and medical device makers as part of the state’s 2010-2011 budget....more)

A Guide to Complying With Stark Physician Self-Referral Rules
Written by a team of experienced health care attorneys, this guide features explanations of prohibitions and exceptions under Stark, chapters on the special Stark interests of medical groups, health plans, hospitals, etc., and summaries of OIG-issued Stark Advisory Opinions. Click here.

(7) Sen. Chuck Grassley (R-Iowa) introduced a bill Jan. 28 that will attempt to deter fraud, waste and abuse in Medicare and other federal health care programs....(more)

New Marketing Rules and Enforcement Affecting Medicare Advantage and Part D Plans
This report features case studies and analysis of CMS actions, including the suspension of marketing and enrollment against several major MA and Part D plans, and new corrective action plans reached with many other plans. Click here for details.

(8) Aurora Health Care Inc., in Milwaukee, is facing several lawsuits claiming it violated Wisconsin’s privacy laws by including personal medical information when filing claims against debtors, according to the Journal Sentinel....(more)

(9) A licensed practical nurse at Our Lady of Perpetual Help in Virginia Beach, Va., was sentenced to two years in prison for aggravated identity theft and stealing the identities of nursing home patients, according to a Jan. 19 press release by the U.S. Attorney’s Office for the Eastern District of Virginia....(more)

(10) A new ethics complaint accuses former Kansas attorney general Phill Kline of widespread abuse of office, according to the Kansas City Star....(more)

Additional government news can be found at
AIS's HEALTH BUSINESS DAILY

 

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Mental Health Parity: How to Comply With New Final Regs

A Webinar
Thursday, February 25, 2010.
Click here for details.


RACs: Strategies to Reduce Your Risk and Successfully Appeal Payment Denials
Learn about auditing and evaluating particular areas before the RACs do, establishing processes for records requests and appeals, and reducing your risk exposure.  Click here for details.


High-Risk Areas in Medicare Billing: Compliance Auditing Tools for Hospitals and Health Systems  

Click here


The Aging of America: Implications for the Business of Health Care
A
clearinghouse of data, trends, projections and research findings.
Click here.



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