The Affordable Care Act contains many provisions intended to eliminate or reduce improper or fraudulent Medicare and Medicaid payments. Hospitals will continue to feel ever-increasing scrutiny association with their participation in these government programs. Despite problems and redundancies that hospitals have identified in federal and state program integrity efforts, hospitals are committed to help reduce fraud and abuse.
Last week, the U.S. Department of Health and Human Services (HHS) released the attached rule finalizing parts of the Affordable Care Act (ACA), including provisions regarding marketplaces (exchanges). The rule outlines program integrity standards for advance payments of the premium tax credit, cost-sharing reductions, premium stabilization programs, and state marketplaces, as well as oversight of insurers offering coverage in the federally facilitated marketplaces and standards for HHS-approved enrollee satisfaction survey vendors.