ASC Coding, Billing & Collections

A physician in Largo, Fla., has agreed to pay $350,000 to resolve False Claims Act allegations that he submitted fraudulent Medicare claims. The Justice Department alleged that between September 2015 and December 2020, John Michaelos, MD, owner of St. Michael’s…

UnitedHealthcare’s acquisition of nearly 300 ASCs over the last decade wasn’t associated with reduced procedure volume, fewer physicians, changes to patient mix or worse quality of care, according to a study published in the September issue of Health Affairs. The…

Tampa, Fla.-based Pulmonary Associates of Brandon has agreed to pay $419,410 to resolve allegations that it violated the False Claims Act by submitting Medicare claims for evaluation and management services that should have been billed under a lower-paying code, according…

UnitedHealthcare negotiated significantly lower facility fees than rival insurers at the very ASCs it owns, according to a study published in the September issue of Health Affairs. Researchers from Brown University, Columbia University, RAND Corp. and Cornell University used 2023…

Optum’s SCA Health now operates more than 370 ASCs and surgical hospitals across 38 states, with more than 60 health system partners and thousands of total joint replacements performed every month. That scale is exactly what’s letting the company build…

A federal jury convicted three defendants in an $11 million Medicaid fraud and kickback scheme involving a Henrico, Va.-based mental health agency, according to a Sept. 9 Justice Department news release. Twin sisters E’mon and Armone’ Ambers, 31, and Traquan…

UnitedHealthcare recently announced it’s cutting prior authorization requirements by 30%, including for some outpatient surgeries, by the end of 2026.  Four surgeons connected with Becker’s to share their reaction to the announcement and how prior authorization has shaped their practices.…

A federal judge ordered the redaction of two physicians’ names from all unsealed filings in a dismissed qui tam case under the False Claims Act, a departure from how courts have typically ruled on such requests, according to a Sept.…

Two Florida men were sentenced to prison for their roles in a $34.8 million Medicare fraud scheme involving unnecessary orthotic braces, according to a Sept. 4 Justice Department news release. Kenneth Kessler III of Miami, was sentenced to 33 months…

PhyxUp Health launched PhyxUp Billing, an AI-powered tool designed to automate revenue cycle workflows for remote therapeutic monitoring. The platform supports six RTM CPT codes and automatically populates more than 30 claim fields. Its billing “engine” runs more than 40…