A 2024 CMS rule now requires payers, including Medicare Advantage plans, Medicaid, CHIP and ACA exchange carriers, to publicly report prior authorization metrics for the first time. The public reporting mandate arrives after years of mounting frustration over prior auth…
ASC Coding, Billing & Collections
There is a stark split across specialties in how physician compensation is structured, according to recent data from the American Medical Association. Psychiatrists and pediatricians draw roughly two-thirds of their pay as salary, with little tied to how much they…
While compensation rose roughly 3% across the board in 2025, an April 10 Medscape report found.a stark divide between the highest and lowest-paying specialties. The report, which surveyed 5,916 physicians across more than 29 specialties from Sept. 5 to Dec.…
Acting U.S. Attorney General Todd Blanche launched the National Fraud Enforcement Division on April 7, consolidating the Justice Department’s fragmented fraud units into a single, centralized division with an aggressive mandate: protect more than $1 trillion in taxpayer-funded program spending…
A Southern California man who operated a network of medical clinics has been sentenced to 216 months in federal prison for running a drug trafficking ring that sold thousands of illegal oxycodone prescriptions for cash, the Justice Department said in…
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A Buffalo, N.Y.-area radiologist who sued his former practice and its acquirer in 2025 is now facing a countersuit from eight former colleagues seeking at least $250,000 in damages, Buffalo Business First reported April 7. Gregory Ball, MD, filed a…
A physician advocacy group is calling on CMS to include safeguards for small independent practices as the agency ramps up its fraud, waste and abuse enforcement efforts, according to an April 6 news release from the Physicians Advocacy Institute shared…
A Texas physician has been indicted on charges of operating a cash-only clinic in Houston to sell prescriptions for controlled substances, the Justice Department said in an April 2 news release. James Robles, MD, of Weslaco, Texas, allegedly conspired to…
Eight defendants, including three nurses, a chiropractor and a purported psychologist, have been arrested on federal charges alleging they schemed to defraud the healthcare system out of more than $50 million, the Justice Department said in an April 2 news…
Steubenville, Ohio-based Trinity Hospital has agreed to pay $1.7 million to resolve allegations of improper financial relationships with two referring physicians in violation of the Stark law, the Justice Department said in an April 2 news release. Between 2014 and…