A married couple living in Birchwood, Tenn., have been sentenced for a $65 million TriCare fraud scheme. 

Becker's has reported on three major payer contract splits and resolutions that have affected ASCs since Dec. 5:

The North Carolina Supreme Court has granted review in September for a lawsuit from Jay Singleton, MD, who owns an ophthalmology practice in New Bern, N.C., challenging the state's certificate-of-need laws. 

The Federal Trade Commission has been largely silent on its proposed ban on noncompete contracts for full-time employees and independent contractors introduced January 2023, according to an article by law firm BakerHostetler published in JDSupra.

Indianapolis-based Community Health Network recently agreed to pay $345 million to resolve claims it violated the False Claims Act and Stark law, indicating the importance for providers to pay close attention to physician compensation arrangements, law firm Baker Donelson wrote in a Jan. 22 article published by JDSupra. 

Many physicians have experienced challenges stemming from Stark law, which bans them from making referrals for Medicare-payable health services if the physician or immediate family member has a financial relationship with the entity. 

Earlier this year, New York Gov. Kathy Hochul vetoed a bill that would've banned noncompetes and added the state to a short list of those prohibiting noncompetes. 

Two ASC leaders joined Becker's to discuss the payer trends that are affecting ASCs in the most significant ways at the moment. 

CMS has finalized prior authorization and electronic health information policy updates that are expected to create approximately $15 billion in savings over the next 10 years. 

St. Louis-based nimble solutions, an ASC revenue cycle management company, named Kelley Blair CEO.

A bill that would strengthen healthcare price transparency at ASCs has been introduced in the Senate, according to a news release from Indiana Sen. Mike Braun. 

A circuit court has reinstated a suit from the Costa Mesa, Calif-based South Coast Specialty Surgery Center accusing Blue Cross of California, which does business as Anthem Blue Cross, of racking up more than $5.4 million in unpaid claims. 

Five physician leaders joined Becker's to discuss the payer behavior they'd like to see changed in 2024. 

This year is shaping up to be a big one for major U.S. payers, with several new rules going into effect. 

The ever-changing payer landscape requires leaders to be nimble in order to navigate it successfully.  

In January 2023, the Federal Trade Commission proposed a rule that would ban noncompete contracts for full-time employees and independent contractors. 

UnitedHealthcare Group, Cigna and CVS Health-backed insurer Aetna, three of the largest U.S. insurers by membership, each had an eventful 2023. 

Nearly 200 members of Congress have co-signed a bipartisan letter urging House and Senate leaders to pass legislation addressing 2024's Medicare physician pay cuts, according to a Jan. 4 report from the American Medical Association. 

Cigna is reportedly in "advanced talks" to sell its Medicare Advantage business to Chicago-based health insurer Health Care Service Corp., according to a Jan. 3 report from The Wall Street Journal.

The reimbursement disparity between hospital outpatient departments and ASCs is frustrating leaders as costs soar.