Broker Regulation

The Department of Justice has obtained a $3.4 million default judgement against a Nebraska pharmacist and pharmacy company over allegations of fraudulent billing to Medicare and Medicaid.

Forty-two Texas hospitals received warnings, which is the most of any state.

The Clear Healthcare Expense Cost Knowledge (CHECK) Act increases disclosure obligations for PBMs, TPAs and insurers while tightening billing timelines and penalties across the health care system.

The regulator approves the acquisition contingent on the sale of seven surgery centers across five metro markets, citing risks to pricing and quality in key outpatient specialties.

"Employers must now prepare for dual compliance at both federal and state levels, and advisors play a critical role in ensuring they're ready," said Wes Hill, vice president, regulatory affairs, for RxBenefits.

The leadership transition adds uncertainty for drug approvals, treatment access and regulatory direction.