CMS’ decision to phase out the inpatient-only list could reshape how surgery itself is approached. However, according to two orthopedic and spine surgeons who have built their careers around the shift to outpatient surgery, eliminating the list does not have…
ASC Coding, Billing & Collections
A physician in Texas was sentenced to 12.5 years in prison for operating a medical clinic as an illegal pill mill. Maryam Qayum, MD, owned, operated and was the sole prescriber at Recare Health Clinic in Houston. The clinic was…
The Justice Department’s decision to decline prosecution of Campus Eye Management Holdings while separately indicting its founder turned a spotlight on a corporate structure that has become the default architecture for private-equity-backed provider roll-ups. The structure, with the management services…
A Nevada physician has been indicted on charges of billing Medicare more than $95 million for medically unnecessary amniotic wound allografts, including procedures performed on elderly patients in hospice care, the Justice Department said in an Aug. 5 news release.…
Stark law was created to prevent financial conflicts of interest in physician referrals, but many healthcare leaders say the decades-old regulation has become increasingly difficult to navigate as care delivery evolves. For physician organizations and ambulatory surgery centers, the law’s…
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A wave of second-quarter 2026 earnings calls from the nation’s largest for-profit hospital operators shows a pattern of exchange patients converting almost 1-to-1 into uninsured patients as enhanced ACA marketplace subsidies expire due to HR 1. However, inpatient and hospital-based…
Leapfrog Group’s new ASC Public Reporting Program ran into an obstacle hospitals rarely face: a meaningful share of ASCs still don’t have the systems in place to track their own quality data. “We found that ASCs have many more barriers…
In the back half of July 2026, the Department of Justice brought at least four separate enforcement actions touching ophthalmology within about two weeks, and the cases point to three vulnerabilities baked into how ophthalmology practices generate revenue. Drugmaker EyePoint…
A Jacksonville, Fla.-based Medicare Advantage MSO has agreed to pay $14.1 million to resolve False Claims Act allegations of submitting false diagnosis codes to inflate risk adjustment payments, the Justice Department said in an Aug. 3 news release. Complete Health…
Boston-based Ophthalmic Consultants of Boston has agreed to pay nearly $3.9 million to resolve False Claims Act allegations of improperly billing Medicare and MassHealth for office visits in addition to intravitreal injection procedures, the Justice Department said in a July…