A Missouri man was sentenced to 10 years in prison for orchestrating a Medicare fraud scheme that generated more than $174 million in genetic testing claims, according to a Dec. 12 news release from the U.S. Department of Justice. What…
ASC Coding, Billing & Collections
A New York physician was sentenced to seven years in prison for his role in a scheme that resulted in more than $24 million in fraudulent claims to Medicare, according to an Oct. 23 Justice Department release. What happened?
More than 400,000 Cigna Healthcare members in Arizona could lose access to Tenet Healthcare’s Phoenix-based Abrazo Health network if the two organizations fail to reach a new agreement by the end of the year, the Phoenix Business Journal reported Dec.…
Most ASC leaders Becker’s spoke with summed up the 2025 payer environment in a single word: challenging. Four of the five leaders pointed to intensifying prior authorization and referral requirements, rising denials, and shrinking reimbursement, all as supply and operating…
Providers of healthcare in the US have increasingly been pushed aside and commoditized by hospitals and insurers. As such our healthcare payment system is deeply flawed, with high costs, unequal access, and complex reimbursement systems. This paper proposes a three-tiered,…
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Greg DeConciliis, administrator of Boston Out-Patient Surgical Suites and president of the Massachusetts Association of Ambulatory Surgery Centers, told Becker’s that he sees volume growth and operational discipline as the clearest path through today’s cost pressures. “The only solution is…
Next Bio-Research Services, doing business as Next Molecular Analytics, has agreed to pay at least $758,000 to settle allegations it paid illegal kickbacks to physicians and marketers, according to a Dec. 4 Department of Justice news release. What happened?
Greg DeConciliis, administrator of Boston Out-Patient Surgical Suites and president of Massachusetts Association of Ambulatory Surgery Centers, joined Becker’s to discuss his team’s data-first, payer-education approach to rate defense. Editor’s note: This interview was edited Question: How are you approaching…
Ameet Vohra, MD, owner of Miramar, Fla.-based Vohra Wound Physicians Management, and his companies have agreed to pay $45 million to resolve allegations that they violated the False Claims Act by knowingly submitting claims for medically unnecessary surgical procedures to…
CMS will make significant changes to ASC and outpatient surgery reimbursement next year. In the 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule, published Nov. 21, CMS outlined plans to increase ASC pay and allow for…