Elevance Health’s out-of-network penalty policy has been met with significant resistance — and another lawsuit filed Sept. 17 is adding fuel to the fire. The Neurological Surgery Practice of Long Island filed the complaint in a New York federal court,…
ASC Coding, Billing & Collections
Management services organizations and physician practice management platforms depend on the management fee paid by the clinical practice to the MSO, but an unvalidated or inflated fee is drawing intensifying federal and state fraud scrutiny, according to a Sept. 15…
Atlanta-based federal prosecutors have filed a False Claims Act complaint against two laboratory executives accused of orchestrating Medicare testing schemes that targeted faith-based communities and senior living facilities, according to a Sept. 17 news release from the Justice Department. Jay…
CMS’ 2026 Medicare Physician Fee Schedule raised the conversion factor to $33.57 for qualifying participants, a 3.77% increase. Buried in the same rule is a 2.5% efficiency adjustment to the work RVU values on roughly 7,700 non-time-based CPT codes, covering…
San Tan Valley, Ariz.-based Rita Ntusa Anagho has been sentenced to 14 years in federal prison for orchestrating a $69 million Medicaid fraud scheme through her addiction treatment clinic, according to a Sept. 17 news release from the Department of…
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PHI Air Medical, an air ambulance company, suspended operations at the Red Bluff Air Medical Base at Red Bluff Airport in California amid reimbursement tensions with insurers. A Sept. 14 PHI news release shared with Becker’s specifically blamed Elevance Health,…
Durango, Colo.-based physician Daniel Caplin has been sued by Colorado Attorney General Phil Weiser over allegations he defrauded Colorado Medicaid of more than $374,000, according to a Sept. 15 news release. Dr. Caplin allegedly continued billing Medicaid for opioid addiction…
A new retrospective study comparing carpal tunnel release performed at an ASC against a clinic-based procedure suite found no meaningful difference in patient outcomes, but a stark gap in efficiency that could push more of these cases out of the…
Two New York ophthalmology practices’ $2.3 million settlement over outside transcranial doppler testing arrangements is the latest example of a Stark law problem hiding in plain sight: a referral relationship that looks like routine outsourcing but fails the law’s ownership…
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…