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The Daily Scan

Last Updated: 8:50 AM EST


  • The office of Inspector General for the Department of Health and Human Services recently conducted a study to determine the extent to which the data reported about Open Payments was missing elements, or was inaccurate and to determine the role of CMS in validating Open Payments data received from manufacturers and group purchasing organizations. What the OIG found was of 11.9 million records published on the Open Payments website for 2015, less than 1 percent were missing required data elements. Although the Open Payments data elements reported to CMS were complete overall, the OIG did identify records that contained inaccurate, imprecise, or inconsistent information. The OIG recommends that CMS take a number of practical steps to improve the accuracy, precision, and consistency of the data to better help consumers use the information: (1) ensure that records contain all required data; (2) strengthen validation rules and revise data-element definitions so that actual drug and device names must be reported; (3) revise the definition of the device-name data element so that the information reported is required to be more specific; and (4) ensure that manufacturers and group purchasing organizations report valid NDCs for drugs. (OIG.HHS.gov)

  • WakeMed Raleigh Campus, a hospital in Raleigh, NC went under a compliance review by the OIG, this resulted in the OIG finding that WakeMed complied with Medicare billing requirements for 187 of the 263 inpatient claims that the OIG reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 76 claims, resulting in net overpayments of approximately $250,000 for the audit period. The OIG recommends the following for WakeMed Raleigh Campus, “that the Hospital refund to the Medicare program $697,608 in estimated overpayments for the audit period for claims that it incorrectly billed; exercise reasonable diligence to identify and return any additional similar overpayments received outside of our audit period, in accordance with the 60-day repayment rule, and identify any returned overpayments as having been made in accordance with this recommendation; and strengthen controls to ensure full compliance with Medicare requirements.” (OIG.HHS.gov)

  • Yesterday, California Attorney General Xavier Becerra filed a Freedom of Information Act (FOIA) request with the U.S. Department of Health and Human Services (HHS), U.S. Department of Homeland Security (DHS), and U.S. Department of Justice (DOJ) seeking information about the Trump Administration’s enactment of the “zero tolerance” border policy separating children from their families. Attorney General Becerra commented, “the Trump Administration owes all of us answers over this cruel and immoral child separation policy. We will not accept the silence of federal officials, last week’s Congressional hearing shows that this President and his Administration received warnings about the impacts of the family separation policy and still acted. We must have answers and accountability." (OAG.CA.gov)

  • State insurance regulators have expressed confusion over the Trump Administration's new rule expanding association health plans. Late last week, Pennsylvania Insurance Commissioner Jessica Altman sent a letter to Labor Department Secretary Alex Acosta and HHS Secretary Alex Azar stating that, contrary to the federal rule finalized in June, associations cannot form for the primary purpose of selling health insurance. Altman wrote, "we have reviewed the Final Rule promulgated by the Department of Labor titled “Definition of ‘Employer’ Under Section 3(5) of ERISA – Association Health Plans” (“AHP Final Rule”)1, in light of the Public Health Service Act (“PHSA”), administered by the Department of Health and Human Services, and Pennsylvania law." Altman has cited Pennsylvania law within the rest of the letter relating to the new rule and the threats it makes to the stability of their markets. (ModernHealthcare.com, Insurance.PA.gov)


  • Yesterday, the Centers for Medicare and Medicaid Services (CMS), gave notice of a proposed rulemaking called "Patient Protection and Affordable Care Act; Methodology for the HHS-operated Permanent Risk Adjustment Program for 2018 Proposed Rule." This rule proposes to adopt the risk adjustment methodology that HHS previously established for the 2018 benefit year which uses the statewide average premium in the payment transfer formula. CMS Administrator Seema Verma commented, “today’s proposed rule continues our effort to help stabilize the individual and small group markets, our goal has been, and will continue to be, to stabilize the market and provide American consumers with more affordable health coverage options.” (CMS.gov)


  • The Ministry of Public Health of the Democratic Republic of the Congo announced the launch of Ebola vaccinations for high risk populations in North Kivu province. This comes one week after the announcement of the second outbreak of Ebola this year in the country. Dr Matshidiso Moeti, WHO Regional Director for Africa commented, "we are proud of the regional solidarity demonstrated by the vaccination efforts, and confident that the strong capacity of the African region will once again be demonstrated during the response to this outbreak." (WHO.int)

#Regulation #Legislation #International


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