April 18, 2012
The U.S. Department of Health and Human Services (HHS) has entered into another settlement for the violation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), this time with a small physician practice that violated HIPAA while using Internet-based calendar and email services.
Phoenix Cardiac Surgery, P.C., of Phoenix and Prescott, Arizona, has agreed to pay HHS a $100,000 settlement after it was reported that the physician practice violated HIPAA by posting clinical and surgical appointments for its patients on an Internet-based calendar that was publicly accessible. The HHS Office for Civil Rights’ (OCR) investigation also revealed that Phoenix Cardiac Surgery violated HIPAA by emailing patient information from an Internet-based email account to workforce members’ Internet-based email accounts.
December 1, 2011
On November 21, 2011, the Center for Consumer Information & Insurance Oversight (“CCIIO”), in the Centers for Medicare & Medicaid Services (“CMS”), announced its determination that a health insurance premium rate increase of 11.58 percent in the small group market in Pennsylvania represented an “unreasonable” rate increase, while an 11.10 percent increase in the individual market in Montana did not. These long-awaited determinations represent the first application of CMS’s rate review regulations under federal health reform. This Implementing Health and Insurance Reform alert discusses these first federal rate review determinations, and their implications for insurance carriers and future insurance premium rate reviews.
October 26, 2010
The U.S. Department of Health and Human Services (“HHS”) recently issued several program guidances and announcements related to two federal prescription drug pricing programs: (1) the Section 340B Discount Drug Program (“340B Program”), administered by the Health Resources and Services Administration (“HRSA”); and (2) the Medicaid Drug Rebate Program (“MDRP”), administered by the Centers for Medicare & Medicaid Services (“CMS”). We have set forth below an overview of these recent developments.
I. 340B Program: Two Advance Notices of Proposed Rulemaking: Public Comments Sought
October 6, 2010
As we await federal medical loss ratio (“MLR”) standards and federal rulemaking by the Secretary of the US Department of Health and Human Services (“HHS”) related to new federal reporting obligations by health insurance issuers of “unreasonable premium increases,” it is helpful to consider recent health insurance premium rating activities and challenges in Massachusetts. In summary, on April 1, 2010, the Massachusetts Division of Insurance (“Division”) disapproved all premium rate increases filed by health insurance carriers for small business and individual customers that exceeded 7.7 percent – which was 150 percent of the New England Medical CPI for 2009. The affected health insurance carriers filed administrative appeals of the Division’s disapprovals of their premium rates. All of these administrative appeals have now been resolved, with mixed results. This client alert summarizes the Massachusetts rate disapproval proceedings and resolutions, the new Massachusetts rate filing legislation, and the implications of the Massachusetts experience for national health reform.