A former Brookline, Mass. physician has been sentenced to 58 months in prison for healthcare fraud, money laundering and tax evasion, the Justice Department said in a June 8 news release. Pankaj Merchia, MD, 52, was convicted in January 2026…
ASC Coding, Billing & Collections
A recent 11th Circuit Court of Appeals ruling clarified how federal prosecutors are able to charge physicians and executives for false statements in healthcare fraud cases, according to a blog post from law firm Armstrong Bradylyons. The case involved an…
The fight between ASCs and payers used to come down to rates. From authorization delays that strand patients in need of surgery to anesthesia reimbursement that treats fixed coverage like a variable cost, ASC leaders say the pressure now runs…
A former chiropractic clinic chain executive has pleaded guilty to filing a false tax return related to an illegal tax shelter used to conceal nearly $1.3 million in taxes, the Justice Department said in a June 5 news release. Stuart…
The No Surprises Act, implemented in 2022, was designed to shield patients from unexpected medical bills and set up an independent dispute resolution process for payers and physician groups to settle out-of-network payments. But the law has become a flashpoint…
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A proposal that would strip Medicare coverage from widely used peripheral nerve block procedures is still active nearly eight months after five Medicare Administrative Contractors published draft local coverage determinations in October. The proposed LCDs would classify therapeutic peripheral nerve…
Pairing a low average cost per case alongside strong outcomes can give independent ASCs a leg up when negotiating contracts with payers. For ASCs that are affiliated with a health system, same-day surgery conversions and site-of-service migration rates can create…
HHS, CMS and the departments of Labor and Treasury finalized a rule May 28 overhauling the No Surprises Act’s independent dispute resolution process, instituting several changes aimed at increasing efficiency and transparency in a process that has been criticized by…
The HHS Office of Inspector General issued an unfavorable advisory opinion this month, concluding that an orthopedic device company’s plan to pay physician consultants royalties tied to product-line revenue posed a heightened risk under the federal Anti-Kickback Statute. Here are…
Matrix Medical Network, a Nashville, Tenn.-based health services company that conducts in-home assessments for Medicare Advantage patients, has agreed to pay $36.5 million to resolve False Claims Act allegations of generating false and invalid diagnoses to artificially inflate risk adjustment…