OIG Corporate Integrity Agreements and Physician Compliance Programs

In settling allegations of violating the False Claims Act (FCA), healthcare providers often enter into a Corporate Integrity Agreement with the OIG in exchange for the OIG’s agreement not to exclude the provider from participation in Medicare or other federal health care programs. Corporate Integrity Agreements (CIAs) generally require a provider to establish or supplement an existing compliance program, with detailed requirements described in the CIA. Continue reading

Plans Offered by Insurers on Louisiana’s ACA Exchange Hiking Rates by Double-Digits

Nearly 211,000 Louisiana residents covered under an “Obamacare” plan can expect to see rate hikes between 16.4 and 30.75 percent in 2017. The premium hikes are meant to cover the massive losses the plans have accumulated. Insurer’s filings with the Louisiana Insurance Department detail enrollee’s increased use of services, higher costs of benefits and prescription drugs and lower payments from a federal program meant to protect insurers from unexpectedly high claims and losses. Among the plans proposing increases are Blue Cross and Blue Shield of Louisiana, Aetna Health Inc., Humana Health Benefit Plan of Louisiana Inc., and Vantage Health Plan Inc. In April, UnitedHealth pulled itself from the ACA Exchanges in Louisiana and most other states after it says their plans in those states accumulated losses of more than $1.1 billion nationally over a two-year period. UnitedHealth’s departure from Louisiana’s ACA Exchange will leave approximately 29,000 people looking for a new insurer for 2017.

Louisiana Governor Signs Legislation Banning Common Abortion Procedure

On June 1, 2016, Gov. John Bel Edwards signed a bill into law that bans the second-trimester abortion procedure known as “dilation and evacuation.”  This makes Louisiana the sixth state to prohibit this abortion method.  Under the new law, called the “Unborn Child Protection from Dismemberment Abortion Act,” the procedure will only be allowed if necessary to prevent “serious health risk” to the mother.  The law takes effect on August 1, 2016.   Only the performing physician will be legally responsible and subject to penalties for violations of the ban.  The penalties could include loss of license to practice medicine and the possibility of a fine up to $1,000 and a prison sentence of up to two years.

It is unclear whether this law will stand up to a legal challenge.  A similar law was blocked by state courts in Kansas and Oklahoma as violating the state Bill of Rights and the Due Process Clause of the Fourteenth Amendment of the U.S. Constitution.

See full text of the Unborn Child Protection from Dismemberment Abortion Act here.

Written by: Catherine Moore

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Enrollment Begins for Louisiana’s Medicaid Expansion

Beginning June 1, 2016, Louisiana residents with a household income below 138 percent of the federal poverty level will be eligible to obtain healthcare coverage through the state’s Medicaid program. On January 12, 2016, Gov. John Bel Edwards signed an executive order to expand the Medicaid program, making Louisiana the 31st state to extend Medicaid.

The U.S. Department of Health & Human Services also approved a new approach to Medicaid enrollment that will allow Louisiana to use information from the Supplemental Nutrition Assistance Program (SNAP) to determine eligibility and enroll individuals in Medicaid.  Louisiana is the first state to be approved to use this enrollment strategy through the use of a state plan amendment.

Quick Facts:

  • Enrollment began on June 1
  • Coverage will be effective July 1
  • The State of Louisiana estimates that 375,000 new adults will enroll in coverage, with about 105,000 people already enrolled in SNAP identified as likely eligible for coverage.
  • Through 2016, the coverage for newly enrolled adults of up to 138% of the federal poverty line is completely funded with federal money. However, federal funding rates will decline beginning in 2017 (Federal funding rates will not fall below 90% of costs). [1]

[1] U.S. Department of Health & Human Services, HHS Secretary Sylvia M. Burwell Applauds Louisiana Medicaid Expansion Under the Affordable Care Act, (May 31, 2016).

Written by: Catherine Moore

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