ASC Coding, Billing & Collections

The Department of Justice announced Jan. 12 that False Claims Act settlements in 2025 exceeded $6.8 billion—the highest annual total in the history of the statute. In a Jan. 26 report, JD Supra outlines four other key takeaways from the…

Medical malpractice verdicts topping $10 million — often dubbed “nuclear” awards — are becoming more common as juries hand down eye-popping damages for catastrophic injuries and wrongful deaths.  Physician groups, including the American Medical Association, have warned that the post-COVID-19…

Brian August, MD, a physician in El Paso, Texas, has agreed to pay $200,000 to resolve allegations that he violated the Controlled Substances Act, the False Claims Act and the Texas Health Care Program Fraud Prevention Act.  According to a…

As payer prior authorization requirements grow more complex, ASCs are increasingly caught in what one administrator describes as a “game of chicken” between patient care and financial survival.  Elisa Auguste, administrator at East Setauket, N.Y.-based Precision Care Surgery Center and…

A former Saginaw, Mich., physician will be tried on 23 counts of Medicare fraud and false claims, according to a Jan. 22 news release from the Michigan Attorney General. What happened?

Denials, audits and delayed payments are accelerating across ASC, and leaders say payer behavior has become more aggressive, automated and less collaborative over the past year.  Five ASC executives joined Becker’s to discuss how they’re adapting, from tightening documentation and…

As employers push patients to lower-cost sites of care and regulators nudge providers toward downside risk, value-based care is moving from theory to reality, and it is coming at “lightning speed,” according to Dan Tasset, founder and chairman of Leawood,…

Medicare Advantage markets remain highly concentrated across the U.S., according to the American Medical Association’s new report, “Competition in Health Insurance: A Comprehensive Study of U.S. Markets.” AMA researchers analyzed data from 2024 across 384 metropolitan areas, all 50 states…

Consolidation among health insurers has damaging effects on independent physician practices and their patients, according to the American Medical Association’s new report, “Competition in Health Insurance: A Comprehensive Study of U.S. Markets.” AMA researchers analyzed data from 2024 across 384…

Lafayette, La.-based Priority Hospital Group, three of its managed long-term care hospitals and a physician are facing allegations of violations of the False Claims Act tied to medically unnecessary care and improper patient referrals, according to a Jan. 21 news…