BCBS Reaches $2.8 Billion Settlement to Resolve Antitrust …
Dec 17, 2024 · Blue Cross Blue Shield (BCBS) – with 33 of its member companies – recently reached a proposed settlement, agreeing to pay $2.8 billion to settle allegations that BCBS plans violated antitrust laws by suppressing competition and underpaying providers for reimbursements from July 2008 to October 2024.This class action proposed settlement represents the largest antitrust payout to be awarded ...
CVS Subsidiary Reaches $60 Million Settlement Over False Claims …
Nov 11, 2024 · Oak Street Health, a wholly-owned subsidiary of CVS Health since 2023, has agreed to pay $60 million to resolve allegations that it violated the False Claims Act (FCA) by paying kickbacks to third party insurance agents in exchange for their recruiting of seniors to Oak Street Health’s primary care clinics.. The United States alleged that prior to CVS’ ownership, in 2020, Oak Street Health ...
Navigating Change: SAMHSA’s New Federal Guidelines for Opioid …
Dec 6, 2024 · The Substance Abuse and Mental Health Services Administration (SAMHSA) has recently released a comprehensive updates to the Federal Guidelines for Opioid Treatment Programs (OTPs), reflecting the significant changes to the regulations published in February 2024. These new guidelines, which supersede those from 2015, offer detailed recommendations, guidance, and best practices for the ...
DEA and HHS Extend Telehealth Flexibilities for Controlled …
Jan 10, 2024 · The rule’s publication drew significant opposition from the provider stakeholder community, with the DEA receiving more than 38,000 comments in response, most of which scrutinized DEA’s perceived shortsightedness and burdensome requirements for typical prescribing relationships.
Biden Administration Rescinds Trump Administration Insulin …
Oct 26, 2021 · One of the final healthcare actions made by the Trump Administration has been rescinded by the Biden Administration. On December 23, 2020, the Trump Administration finalized a rule that directed the Department of Health and Human Services (HHS) to take action to require that federally qualified health centers (FQHCs) make insulin and injectable epinephrine available to certain patients at 340B ...
HHS OIG’s Mary Riordan Outlines New Compliance Priorities at …
Nov 7, 2024 · Looking forward, the OIG Work Plan for 2025 includes investigations in key areas affecting pharmaceutical compliance. Among these are: Medicare Part D coverage of weight-loss medications: The agency will examine drugs prescribed for both diabetes and weight loss, assessing if Medicare payments align with Part D requirements.; FDA Oversight: Future OIG audits will scrutinize the FDA’s role in ...
Endo Reaches $465 Million Bankruptcy Settlement with United …
Apr 15, 2024 · Bankruptcy Settlement. The bankruptcy settlement allows a group of Endo’s secured lenders to purchase Endo’s assets and operate the business under a new corporate structure. The new business will then pay the $364.9 million to the United States over the course of 10 years. It encompasses not only the claims from the criminal and civil settlements, but also tax claims and claims of various ...
ACOs Help MSSP Reach Largest Annual Savings in Program History
Jan 2, 2025 · The Centers for Medicare and Medicaid Services (CMS) found that Accountable Care Organizations (ACOs) and the Medicare Shared Savings Program (MSSP) saved Medicare $2.1 billion in 2023 – the largest annual savings in program history and the seventh consecutive year of savings generated by the program. CMS also noted that MSSP ACOs are “providing higher-quality care and supporting policies ...
Summary of Section 1557 of the Affordable Care Act ... - Policy
Jun 13, 2024 · The United States Department of Health and Human Services (HHS) has issued a final rule under Section 1557 of the Affordable Care Act (ACA) to strengthen nondiscrimination protections and advance civil rights in healthcare. The new rule is effective July 5, 2024 and applies to all healthcare providers who bill Medicare, Medicaid or see patients who are insured through a ACA exchange plan.
December 27, 2024 – Policy & Medicine
Dec 27, 2024 · Legal, Regulatory, and Compliance Issues. Recently, the Centers for Medicare and Medicaid Services (CMS) issued guidance on the second round of the drug price negotiation…