Federal prosecutors have secured guilty pleas or prison sentences in at least six durable medical equipment fraud cases tied to more than $1.5 billion in claims since late May, and CMS has barred 11 DME suppliers from Medicare Advantage payments.…
ASC Coding, Billing & Collections
Plano, Texas-based Heal 360 Urgent Care, Heal 360 Primary Care and their owner, Mohammed Amer Mohiuddin, MD, have agreed to pay $20 million to resolve allegations that they billed a federal COVID-19 program for office visits that never happened, according…
Block utilization at 2-OR ASCs fell to 59% in 2025 from 71% in 2024, while centers with 10 to 14 ORs rose to 59% from 50%, according to HST Pathways’ 2026 State of the ASC Industry Report. The report draws…
Pain management ASCs had a 54% net collection rate in 2025, well below the 87% average across specialties, according to HST Pathways’ 2026 State of the ASC Industry Report. The report draws on data from 682 surgery centers in 45…
Outpatient visits fell 7.5% in May 2026, matching a seasonal dip seen in May and June of 2024 and 2025, according to Chicago-based Strata Decision Technology’s latest Performance Trends Report. The report looks at hospital financial, operational and encounter data…
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Private-payer rates behind CMS’ preliminary 2027 Clinical Laboratory Fee Schedule average about 16% below 2026 Medicare rates. Physician office labs supplied the largest share of the data behind them. CMS estimates the reset could save about $1 billion a year.…
A federal jury in the Western District of Michigan has convicted Rockford, Mich.-based physician Jonathan Decker, MD, of distributing more than 2 million Adderall and other stimulant pills through the Done ADHD telehealth platform, according to an Oct. 2 news…
The federal government’s newest price transparency rule is written for payers, but its effects could reach ASCs well before the first revised rate files post in 2027. CMS and the Labor and Treasury departments finalized an overhaul of the transparency…
Management services organizations take on non-clinical work for physician practices, including billing, revenue cycle, scheduling, compliance, HR and facility management. In states with corporate practice of medicine laws, they are also how private equity firms and other lay investors put…
A Houston physician has been indicted on charges that he and others billed the federal government about $30 million for office visits that were never provided, according to a Oct. 6 news release from the U.S. Attorney’s Office for the…