A Miami physician has been sentenced to federal prison for committing a $38 million healthcare fraud scheme scheme, the Justice Department reported Aug. 3.

Four states and Washington, D.C., have recently updated their governance of agreements that prohibit employees from competing with businesses directly for a specific duration of time after their employment has ended, according to a Aug. 2 report from the National Law Review. 

The Jackson (Tenn.) Clinic, one of Tennessee's largest independent physician groups, has adopted a value-based care model, the group said Aug. 2. 

CMS plans to boost acute care hospital pay 4.3 percent next year, as long as the hospitals comply with quality data reporting.

UnitedHealth Group, parent company of Optum Health and ASC management company Surgical Care Affiliates, saw a busy June and July. Here are 14 UnitedHealth updates from the last 60 days:

Centene is one of the nation's largest health insurers by membership.  Here are 12 updates from the company in the last 60 days:

Aetna, a CVS Health company, insurers about 39 million people.  Here are five updates from the company since July 5:

Payers are incentivizing physicians to perform procedures in low-cost settings, which means ASCs are becoming increasingly attractive. At the same time, physicians are balking at some payer moves in the last 30 days.

Payers are incentivizing physicians to perform procedures in low-cost settings, which means ASCs are becoming increasingly attractive, according to ASC leaders. 

Elevance Health, the insurer formerly known as Anthem, is one of the biggest payers by members with 39.9 million members.

Physicians face another year of fee cuts in 2023 as Medicare proposes to reduce the conversion factor by 4.42 percent to $33.08. 

Medicare is recommending removing 10 procedures from the inpatient-only list in 2023, according to its Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule, released July 15.

Four payers have updated their policy for ASC procedures since May 24:

Health insurance company Cigna is delaying the implementation of its modifier 25 policy.

Peninsula Daily News on July 11 released its picks for the top ASC medical billing companies for 2023.

A federal judge rejected the University of Pittsburgh Medical Center's bid to dismiss a whistleblower lawsuit against UPMC, its physicians group and its chair of cardiothoracic surgery, NBC affiliate WPXI reported July 7.

CMS has released its Medicare physician fee schedule proposed rule for 2023, which suggests further cuts to physician pay while inflation and the cost of running an independent practice continue to rise.

Here are five recent updates on one of the country's largest insurers: 

A retired orthopedic surgeon in Fresno, Calif., was charged nearly $4,000 more for a cataract surgery at a hospital outpatient department than his wife who received the same procedure at an ASC, Kaiser Health News reported June 27. 

UnitedHealthcare is the largest insurer by revenue, according to a June 2022 Value Penguin report.