1. CMS Announces Proposed Payment Rates for Surgery Centers and Outpatient Departments — CMS released its proposed payment rate and policy changes for ambulatory surgery centers and hospital outpatient departments for 2010.
2. Oklahoma Surgery Center Settles Fraudulent Billing Claims for $3.5M — The Orthopedic and Reconstructive Center of Oklahoma in Oklahoma City paid $3.5 million to settle claims by the federal government that it billed payors for medical procedures that were not performed.
3. Federal Court Rules Physician Suit Against Surgery Center for Enforcing Safe Harbor One-Third Tests A Decision for State Court — A Federal Appellate Court ruled that a lawsuit brought forth by a physician-partner of an Illinois surgery center when the center attempted to revoke his partnership because he failed to perform one-third of his cases at the center did not involve federal issues and instead should be heard in state court.
4. CMS Not Covering Surgical Errors — CMS released three new National Coverage Determinations, which state that CMS will not pay for surgical errors.
5. 53 People Indicted for Detroit-Based Medicare Fraud Schemes — Fifty-three physicians, healthcare executives and beneficiaries were indicted in Detroit-based Medicare fraud schemes, which are estimated to have cost Medicare $50 million.
6. U.S. House Introduces First Draft Healthcare Reform Legislation; Seeks to Restrict Physician Ownership — The U.S. House of Representatives issued the first draft of its healthcare reform legislation, which could have a devastating effect on physician-owned hospitals, if passed.
7. Surgery Centers File Lawsuit Against BCBS of Georgia For Out-of-Network Practices — Several surgery centers in Georgia have filed a class-action lawsuit against Blue Cross Blue Shield of Georgia alleging that the insurer discouraged visits to out-of-network healthcare providers by reimbursing procedures at a fraction of the charges.
8. New York Attorney General Reaches Agreement With HealthNet on Out-of-Network Payment Reform — N.Y. Attorney General Andrew Cuomo reached an agreement with California-based insurer HealthNet over flawed out-of-network reimbursement processes.
9. Study Finds That ASCs Pivotal in Moving Services to Clinically Appropriate, Less Expensive Settings — A study by an independent health economics and policy firm found that ASCs play a pivotal role in moving healthcare services into less expensive, yet clinically appropriate settings.
10. Gastroenterology in ASCs: 10 Fast Facts — Ten facts about gastroenterology in ASCs.
