Compliance

Analyze This: Why workers’ comp data gives insurers a strategic advantage

Data analytics has become a key driver in the development of business strategy for leading corporations, and workers’ compensation insurers are uniquely positioned to take advantage of this trend....

CMS Issues New Regulations Aimed at Identifying and Limiting Potential Opioid Abuse

On April 2, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a final rule which updated regulations for Medicare Advantage Plans (MAP) and Medicare Part D programs. The primary foc...

Proactive data management key to handling EDI reporting challenges

Whenever there are changes to industry regulations or compliance standards, there’s always a degree of uncertainty about how they’ll affect insurers. But when IAIABC published its newest standard f...

Texas Court: Medicare Advantage Plans Can Sue for Private Cause of Action under the Medicare Secondary Payer Statute

In Humana v. Shrader , 2018 WL 1384529 (S.D. Tex. March 16, 2018), the federal district court ruled, in part, that the private cause of action (PCA) provision under the Medicare Secondary Payer (MS...

Medicare Advantage Update: Connecticut Court Rules MAPs Can Pursue “Double Damages” Under the Medicare Secondary Payer Statute

Connecticut is the latest jurisdiction to address whether Medicare Advantage Plans (MAPs) have private cause of action (PCA) rights to pursue “double damages” under the Medicare Secondary Payer (MS...

Budget Act of 2018 Limits Medicaid Third-Party Recovery Rights

President Trump signed a budget deal early February 9 th following a brief government shutdown while most Americans were fast asleep. While most of the headlines focused on the deal’s impact on...

CRC Transition Update: Temporary Halt on Recovery Activities

On February 2, 2018, the Centers for Medicare and Medicaid (CMS) issued its latest update regarding the Commercial Repayment Center (CRC) transition from CGI Federal to Performant Financial...

CMS Holds Town Hall Call on CRC Transition - CMS Provides Important Updates on ORM Recovery Transition

On January 18, 2018, the Centers for Medicare and Medicaid (CMS) held its Commercial Repayment Center (CRC) Non-Group Health Plan (NGHP) Town Hall presentation to address the upcoming transition of...

Medicare Advantage Plans Update: Illinois Court Indicates MAPs Have “Double Damages” Rights

Whether Medicare Advantage Plans (MAPs) have private cause of action (PCA) rights to sue claims payers (and others) for “double damages” under the Medicare Secondary Payer (MSP) statute remains a...