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The U.S. Department of Health and Human Services has officially launched its long-awaited Phase 2 HIPAA audit program, the head of HHS’ Office for Civil Rights said at a March 21 conference. The process has begun with the emailing of address verification letters to a pool of potential auditees, said OCR Director Jocelyn Samuels. OCR […]
Runaway prescription drug pricing poses a threat to health plan solvency and to the financial well-being of individuals, because a distorted market allows profit-seeking entrepreneurs to game the system with anti-competitive pricing, health plan executives told attendees at AHIP’s national health policy conference on March 9. Drug spending is growing faster than any other component […]
Monitoring the performance of service providers, making required disclosures to participants and beneficiaries, keeping good records and filing reports with the government are just a few of the important functions a fiduciary must ensure are properly executed, an enforcement official at the U.S. Department of Labor’s Employee Benefits Security Administration unit told a group of […]
An employer may require its workers to participate in a wellness program in order to receive health insurance benefits, a federal district court has ruled, dismissing a lawsuit brought by the U.S. Equal Employment Opportunity Commission. Granting summary judgment for the employer, the U.S. District Court for the Western District of Wisconsin said it disagreed […]
Employers will have 60 more days to send notices to participants and beneficiaries, and about 90 more days to send notices to the IRS about health coverage offered and employees’ health coverage status, the IRS announced Dec. 28. IRS Notice 2016-4 extends the due dates of the information reporting requirements for insurers, self-insuring employers and […]
By Roy Harmon III Several outcomes in an upcoming Supreme Court decision on the extent of health plan subrogation and reimbursement rights could make life more difficult for plans. One outcome in Montanile v. Bd. of Trs. National Elevator Industry Health Benefit Plan would erode health plans’ lien rights if they fail to expeditiously pursue […]
Health plans are unlocking the power of ICD-10 codes and using modern technologies to identify and track the progress of cases to maximize recoveries when plan members have been reimbursed twice for injuries caused by liable third parties, Elizabeth Longo, general counsel for Discovery Health Partners, explained. Unlock the Power of ICD-10 Using data mining […]
A Puerto Rico health insurer agreed to pay $3.5 million in a HIPAA settlement after the U.S. Department of Health and Human Services, investigating multiple breach reports from the company, found what it called “widespread noncompliance” throughout the organization. Triple-S Management Corp. is an insurance holding company that offers many insurance products and services through […]
Employers that purchase small group coverage that is federally regulated under the Affordable Care Act will have additional assurances that their plan members will not be balance billed in certain situations, under proposed rules issued in pre-publication form on Nov. 22. The rule also plans for the adoption of network adequacy provisions to compensate for […]
Thanks to cost pressures exacerbated by the Affordable Care Act, narrow-network plans have increased in popularity because of their lower premiums, but plans using such networks need to think about associated potential problems with poor provider access, balance billing and provider directory information. Detailed information about the latest regulatory and legislative measures to prevent balance […]