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Compliance Reporting Requirements Health Insurance

Compliance programs typically refer to formalized institutional procedures within corporations and organizations to detect, prevent and respond to indvidual and widespread instances of regulatory violations. ... more +
Compliance programs typically refer to formalized institutional procedures within corporations and organizations to detect, prevent and respond to indvidual and widespread instances of regulatory violations.  In response to many corporate scandals evidencing rampant unethical business practices, many nations, including the United States, began passing strict regulatory frameworks aimed at curbing these abuses. Notable pieces of legislation in this area include the U.S. Foreign Corrupt Practices Act (FCPA), Sarbanes-Oxley (SOX), and the U.K. Bribery Act, to name a few. The foregoing statutes and the severe penalties often associated with them form the basis of many modern institutional compliance programs. less -
Hendershot Cowart P.C.

Qlarant, Novitas Audits Escalate as Medicare Skin Substitutes Spending Hits $1.6 Billion, CMS Seeks Evidence of Clinical...

Hendershot Cowart P.C. on

The wound care industry faces unprecedented scrutiny as Medicare Part B expenditures for skin substitutes exceeded $1.6 billion in the fourth quarter of 2023 alone. The spending surge has triggered a wave of skin substitute...more

Bass, Berry & Sims PLC

Reminder – Annual Deadline (July 31) to Report and Pay PCORI Fee is Approaching (UPDATED)

The annual filing (and fee payment) for applicable self-insured health plans and specified health insurance policies used to fund the Patient-Centered Outcomes Research Institute (PCORI fee) is due by Thursday, July 31, 2025....more

Polsinelli

HCPF Makes Clarifications to Mandatory Facility-Based Professionals’ Reporting Requirements Under Colorado Hospital Discounted...

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What is Colorado Hospital Discounted Care? Colorado’s Hospital Discounted Care law, effective September 1, 2022, brought a detailed and comprehensive yet highly confounding overhaul to the way hospitals, freestanding...more

Jackson Lewis P.C.

Make America Healthy Again: New Executive Order Revisits Group Health Plan Price Transparency

Jackson Lewis P.C. on

On February 25, 2025, President Trump signed “Making America Healthy Again with Clear, Accurate, and Actionable Healthcare Pricing Information,” an Executive Order with the stated purpose of making group health plans and...more

Jackson Lewis P.C.

The Guidance Has Arrived! More Information from the IRS on ACA Forms 1095-B and 1095-C

Jackson Lewis P.C. on

Takeaways- Employers may post a notice on their website instead of automatically furnishing Forms 1095-B and 1095-C to all full-time employees. The first due date for such a notice is March 3 for 2024 forms, and the notice...more

Warner Norcross + Judd

IRS Releases ACA Reporting Relief Guidance

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At the end of last year, we told you about new legislation that provides employers with a little Affordable Care Act (ACA) reporting relief. Specifically, under the Paperwork Burden Reduction Act, applicable large employers...more

Amundsen Davis LLC

IRS Issues Guidance on Alternative Distribution Method for Form 1095-C

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As part of the Paperwork Burden Reduction Act, signed into law on December 23, 2024, Internal Revenue Code (IRC) sections 6055(c) and 6056(c) were amended to allow the use of the alternative method for distributing Forms...more

McDermott Will & Emery

How PPM Health Plans Can Solve the MEWA Problem

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While a physician practice management (PPM) structure allows for compliance with corporate practice of medicine laws and ease of administration, it often creates inadvertent health plan issues that should be navigated...more

Woodruff Sawyer

Reminder: RxDC Reporting Due June 1st

Woodruff Sawyer on

With the 2024 reference year RxDC reporting deadline approaching in June, plan sponsors should re-familiarize themselves with the reporting requirements. The 2024 reference year RxDC Reporting Instructions have been released,...more

Mitratech Holdings, Inc

ACA Reporting Deadlines for 2025: What You Need to Know

Understanding reporting rules for the Affordable Care Act (ACA) is more than a best practice. It’s a legal imperative. If your reports aren’t timely and accurate, you face penalties....more

Bass, Berry & Sims PLC

2025 Changes to ACA Employer Information Reporting Obligations and the Employer Shared Responsibility Penalties

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In December 2024, Congress and President Biden passed two laws—the Paperwork Burden Reduction Act (PBRA) and the Employer Reporting Improvement Act (ERIA)—that made important changes to employers’ responsibilities regarding...more

Faegre Drinker Biddle & Reath LLP

Affordable Care Act Penalty and Reporting Relief

The Employer Reporting Improvement Act and the Paperwork Burden Reduction Act (PBA), each signed into law in December 2024, provide the following penalty and reporting relief for plan sponsors required to provide minimum...more

Morgan Lewis - ML Benefits

Welcome Healthcare Reporting Simplification Enacted

On December 23, 2024, President Biden signed into law two bills that will simplify employer reporting compliance under the Affordable Care Act (ACA). The new laws streamline the rules for employers furnishing ACA reporting...more

Polsinelli

Kansas Insurance Department Issues Data Call to All Third Party Administrators Licensed in Kansas

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The Kansas Insurance Department (“Department”) recently issued a Data Call to all Third Party Administrators (“TPAs”) licensed in the state of Kansas. Pursuant to the Data Call, the Department has requested information...more

Bradley Arant Boult Cummings LLP

Significant ACA Improvements for 2025: What Employers Need to Know

The Affordable Care Act reporting requirements are undergoing significant changes in 2025, thanks to the recently enacted Employer Reporting Improvement Act and Paperwork Burden Reduction Act. These changes simplify the...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

2025 ACA Compliance Updates: Essential Insights for Employers

As we turn the page to 2025, employers and HR professionals are turning their attention to ensuring compliance with the reporting and disclosure requirements of the Affordable Care Act (ACA). ...more

Venable LLP

Changes to the ACA: Reporting and Employer Penalties

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President Biden recently signed into law the Paperwork Burden Reduction Act and the Employer Reporting Improvement Act. These new laws make important changes to the Affordable Care Act (ACA)....more

Gardner Law

From Discretion to Regulation: FDA's New Path for LDTs

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Earlier this year, we reported on the expected U.S. Food and Drug Administration (FDA) ruling concerning Laboratory Developed Tests (LDTs). The FDA has consistently shown a commitment to regulating LDTs. On May 6, 2024, the...more

Venable LLP

Important Change to ACA Electronic Reporting

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Beginning in 2024, almost all employers will need to file their Affordable Care Act (ACA) forms electronically. Previously, employers were required to file electronically only if they were filing 250 or more of a specific...more

Bricker Graydon LLP

Gag Clause Attestations due December 31, 2023

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If you sponsor a group health plan, make sure you set a calendar alert before the winter holidays to submit the annual gag clause prohibition compliance attestation. Under the Consolidated Appropriations Act of 2021 (CAA),...more

Health Care Compliance Association (HCCA)

[Virtual Event] 2021 Managed Care Compliance Conference - February 1st - 3rd, 9:30 am - 3:45 pm CST

The first ever VIRTUAL Managed Care Compliance Conference will have the great speakers and content you have come to expect from the in-person event. Each year, we look forward to hosting compliance professionals at our...more

Akerman LLP - HR Defense

Preparing for the Approaching ACA Reporting Deadlines

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With ACA reporting deadlines quickly approaching, many employers should be preparing to address the various reporting requirements in order to avoid the significant fines and penalties associated with non-compliance. As of...more

Ballard Spahr LLP

Reporting for ACA Mandates: Final Forms and Additional Guidance

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The IRS has finalized the 2015 forms and instructions for reporting under the individual and employer mandates and issued additional guidance on these new reporting requirements. The following forms are now available...more

Franczek P.C.

IRS Issues Final ACA Information Reporting Forms and Instructions

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With three months remaining in 2015, the IRS has issued final forms and instructions that employers will need to use to satisfy the Affordable Care Act (ACA) information reporting requirements. The final forms and...more

Franczek P.C.

IRS Provides Updated Guidance on Electronic Filing of ACA Information Returns

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As 2016 approaches, the IRS is issuing more detailed guidance on how employers will need to comply with the upcoming ACA information reporting requirements. As a reminder, the ACA information reporting rules require employers...more

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