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California Blue Shield must repay to consumers $82.8 million. The reason is they did not spend at least 80% of the premiums on medical care. Kaiser and Anthem do not owe refunds. The average rebate to individual consumers is $136. Top
HHS just released a new overview of HIPAA basics. It is nothing new but a reminder of what organizations and offices must do for privacy, security and breach. It behooves people to go to the website and get a refresher course before you are on my legal pages. Top
CMS has delayed to December 31 the partial enforcement delay of the two-midnight rule. There will be RAC post-payment reviews on this until next year.
Medicare has reversed itself and now will pay for Blinctyo, an Amgen medication for a certain aggressive leukemia, that costs about $178,000 for a standard course of therapy. The original application for payment was denied due to non sufficient clinical studies. They then said they received additional studies and are approving the drug. There are no biosimilars for this drug and it is FDA approved. CMS has now said it will pay an add on fee to hospitals for this drug up to $27,000 depending n the length of stay. Typically the treatment starts as an infusion in the hospital and then finishes in a physician's offices.
California has received the all clear from CMS to extend Medicaid coverage to pregnant women in a full range of services. They had prior covered only a limited range of services. There is no mention as to who pays for the increase in services. There never is. Top
DISCLAIMER: Although this
article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the
information presented.