News from the Health Law Gurus™: Week of May 4th, 2014

May 9, 2014 | By Lawrence J. Tabas

News from the Health Law Gurus™ is a weekly summary of notable health law news from around the country with helpful links to related content. Check back every Friday for the latest health law news stories.

Massachusetts to Start from Scratch with Health Insurance Website—Massachusetts plans to abandon its health insurance exchange website in favor of starting over from scratch, according to a New York Times report. The Massachusetts website has been around for years due to the passage of state health care reform in the mid-2000s, but problems arose with the website when it was overhauled to comply with the Affordable Care Act (“ACA”). The Massachusetts decision follows on the heels of Oregon’s decision to scrap its own health insurance exchange in favor of switching to a federally-facilitated exchange through HealthCare.Gov. According to the New York Times, Massachusetts will also be ready to join the federal exchange if the new website is not operational by the 2015 ACA open enrollment period. Read the full New York Times report here.

New York Department of Health in Trouble with OIG—On May 6, 2014, the Department of Health and Human Services Office of Inspector General (“OIG”) released a report finding the New York State Department of Health (“DOH”) claimed $60.8 million in Medicaid reimbursement for unallowable costs. The report noted that a review of the DOH was undertaken “to determine whether DOH claimed reimbursement for unallowable room-and-board costs for residential rehabilitation services provided at State-operated residences under [New York’s] developmental disabilities waiver program.” The OIG found that DOH impermissibly included unallowable costs, like the costs of repairs and utilities, in calculating payment rates, thereby seeking reimbursement for funds not actually due. In addition to paying back the $60.8 million, the OIG recommends that the DOH take steps to ensure that these claims for unallowable costs will not reoccur. Read the report here.

Most ACA Enrollees Have Paid Their Premiums—A little over a month after the close of the 2014 open enrollment period to enroll in a health insurance plan under the ACA, insurers are reporting that most enrollees have paid their premiums. On May 7, 2014, insurance industry officials from Aetna, Inc. and the Blue Cross Blue Shield Association, among others, testified before the House Energy and Commerce Committee that upwards of 80% to 90% of new enrollees had paid their premiums. Read a Washington Post report here.

HIPAA Breach Leads to $4.8 Million in Settlements—According to recent settlement agreements announced by the Department of Health and Human Services (“HHS”) on May 7, 2014, New York and Presbyterian Hospital (“Presbyterian”) and Columbia University (“Columbia”) have agreed to pay $3.3 million and $1.5 million, respectively, to resolve alleged violations of the Health Insurance Portability and Accountability Act. The HHS Office for Civil Rights began investigating Presbyterian and Columbia when it received notice in 2010 of a breach of electronic protected health information that made the information of 6,800 individuals accessible via search engines, like Google. Presbyterian and Columbia must also enter into a corrective action plan as part of the settlements. Read more here.

About the Authors

Lawrence J. Tabas


Lawrence is the Chair for Obermayer’s Health Care Law Department and Election Law Practice Group. Lawrence’s Health Care Law legal experience includes the representation of Pennsylvania County governments in Behavioral Health Managed...

Read More by Author