Legal & Regulatory Issues

Language in the Patient Protection and Affordable Care Act has led two House Republicans to request documentation in hopes of finding a loophole in the way the law will grant subsidies to health insurance customers, according to a report from…

In a new report, the Government Accountability Office identified three key examples of overlap between CMS' Innovation Center and efforts from other CMS offices — posing a risk that CMS may duplicate payments for services.

Parkland Memorial Hospital in Dallas missed its September deadline to pay a $750,000 fine, meaning the public hospital may now owe more money, according to a Dallas Morning News report.

The HHS Office of Inspector General has reported PacifiCare of California may have overbilled Medicare by more than $424 million, claiming the health insurer billed codes and labeled patients with more serious illnesses than medical records indicated.

While tension mounts for Congress to resolve budget negotiations before the year-end "fiscal cliff" deadline, some House Democrats are willing to concede the health reform law's Independent Payment Advisory Board, according to a report from The Hill.

For Karen Bowden, senior vice president of Craneware, a recent recovery auditor appeal took an unscheduled turn, according to a post from Craneware's blog.

A physician is suing Fisherville, Va.-based Augusta Health for $3.35 million in damages, claiming the system fired him after he refused to refer patients exclusively to Augusta hospitals and its medical group, according to a News Virginian report.

The Superior Court of New Jersey ruled against the New Jersey Association of Nurse Anesthetists, and held up a state requirement that anesthesiologists must be present when nurse anesthetists administer anesthesia in hospitals, according to the American Society of Anesthesiologists.

Chicago-based Allscripts Healthcare Solutions, an electronic medical record provider, has sued New York City Health and Hospitals Corp. after the public hospital operator awarded a contract to competitor Epic, according to a Bloomberg report.

The American Hospital Association is running an advertorial in the Wall Street Journal today, saying hospitals today spend too much time and devote too many resources to comply with "regulations that are outdated, duplicative, unfair or even counterproductive."