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| February 9, 2012 |
BNA® News
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Sentencing Guidelines Advisory Group Makes Suggestions on Corporate Compliance Issues
The foundation of compliance program guidances issued by the
Department of Health and Human Services Office of Inspector General
could change if the U.S. Sentencing Commission adopts recommendations
made Oct. 7 by an ad hoc advisory group.
Only 22 Percent of Medicare Claims Comply With Rules as Mid-October Deadline Looms
One week before the deadline for uniform transactions of medical
data, only 22 percent of claims received by Medicare were transmitted
using the new standard, an official with the Centers for Medicare
& Medicaid Services said Oct. 9.
Oregon: Kaiser, CIGNA Offer Mid-Sized Firms In Oregon an 'Insurance Exchange'
PORTLAND, Ore.--Kaiser Permanente Northwest and CIGNA
Healthcare announced Oct. 6 a joint effort to offer mid-sized
Oregon employers a greater choice of health plans.
OSHA Administrator Clarifies Position On Ergonomic Enforcement, Guidelines
The Occupational Safety and Health Administration's new approach to
ergonomics is moving forward successfully and the agency stands behind
its enforcement efforts despite recent criticism, OSHA Administrator
John Henshaw said at the Sept. 24 meeting of the National Advisory
Committee on Ergonomics.
New Jersey: Insurance Department Fines Horizon $200,000 for Claims-Handling Violations
PHILADELPHIA--Horizon Healthcare of New Jersey Inc. will pay a
$200,000 fine and offer a child immunization program to resolve
claims-handling violations cited in a market conduct examination, the
New Jersey Department of Banking and Insurance said Oct. 7.
Action Against Pharmaceutical Pricing, Fraud Among Top Items in FY 2004 Plan
Examining pharmaceutical fraud and drug pricing will be top
priorities for the Department of Health and Human Services Office of
Inspector General in the coming year, the agency said in its Fiscal
Year 2004 Work Plan, released Oct. 1.
California: CalPERS Members Report Improved Care From Its Three Health Plans, Two PPOs
SACRAMENTO, Calif.--Members of the California Public Employees'
Retirement System were more satisfied with their health plans in 2002
than in the previous year, according to a survey of members released
Sept. 16.
California: Health Plans Improving Performance In Some Areas, State 'Report Card' Says
SACRAMENTO, Calif.--Health plans in California have improved their
performance in providing service, paying claims promptly, managing
chronic diseases, and immunizing children, but are not doing as well
with mental health care, disease prevention, and immunizing
adolescents, according to the third annual quality of care report card
released Sept. 30.
IRS Request for Comments on Tax Treatment Of HMOs Draws Varying Views From Attorneys
Taxpayers and practitioners are lining up on either side of a
decision by the Internal Revenue Service to provide new guidance on
the application of Internal Revenue Code Section 501(m) to entities,
such as health maintenance organizations, that are exempt from
taxation under tax code Sections 501(c)(3) and 501(c)(4).
GAO Reports Medicare Beneficiaries Fail to Receive Full Preventive Benefits
While most Medicare beneficiaries receive some of the preventive
services provided by the federal program, relatively few receive the
full range of services available, according to an Oct. 9 General
Accounting Office report.
Massachusetts: Senate Approves Bill to Allow Pharmacists To Fill Prescriptions Received Electronically
BOSTON--The Massachusetts Senate Oct. 7 unanimously approved a
measure (S. 2076) that would allow pharmacists to fill prescriptions
they receive by e-mail.
Colorado: First 'Mandate-Light' Benefits Package Offered in the State Under New Legislation
DENVER--Rocky Mountain Health Plans of Grand Junction,
Colo., is the first health plan in the state to unveil a
"mandate-light" plan under an act approved during the 2003
session of the state General Assembly (H.B. 1164).
District Court Denies Motion to Dismiss, Finds Law Covers Scheme to Defraud HMO
A federal district court Aug. 14 denied a motion to dismiss a
health care fraud charge, rejecting an argument that the criminal
health care fraud statute did not apply to a scheme to defraud a
nonprofit health maintenance organization (United States v.
Baldwin,
D.D.C.,No. 02-0323 (PLF), 8/14/03).
Survey Finds Employers Considering Shift of Health Costs to Their Workers
A survey of 347 employers released Oct. 8 found that 80 percent are
considering employee cost sharing as a strategy to fight health cost
increases.
Alabama High Court Explains Different Burdens of Proof for Carpal Tunnel Injuries
The Alabama Supreme Court Sept. 26 held that for workers'
compensation purposes, the burden of proof for carpal tunnel syndrome
depends on whether the condition was caused by a traumatic accident or
by gradual, cumulative stress (Ex parte USX Corp.
, Ala.,
No. 1020684,
9/26/03).
M+C Plans Must Submit Plan Changes For Enrollees or Risk Their Transfer to FFS
BALTIMORE--Medicare+Choice plans have less than three months to
ensure that their members have a plan benefit package (PBP) number for
2004 or there is a chance the members will be placed in
fee-for-service, a Centers for Medicare & Medicaid Services
official warned Sept. 30.
Emergency Department On-Call Provisions Still Sticking Point for Hospitals, Physicians
On-call provisions in the new Emergency Medical Treatment and Labor
Act regulations remain a problem for some hospitals, which want the
Centers for Medicare & Medicaid Services to provide clearer
standards on the number of physicians that should be available to
emergency departments to meet rule obligations.
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