On Dec. 15, CMS will launch a five-year prior authorization demonstration for certain ASC services in California, Florida, Texas, Arizona, Ohio, Tennessee, Pennsylvania, Maryland, Georgia and New York. According to a Sept. 3 CMS notice, the targeted procedure categories include:…
ASC Coding, Billing & Collections
Two physicians, a laboratory CEO, and seven marketers have agreed to pay more than $6 million to settle allegations of a kickback scheme, the Justice Department said in a Sept. 8 news release. What happened?
A Hyattsville, Md., man has pleaded guilty to stealing physician identities to create fraudulent e-prescribing accounts, the Justice Department said in a Sept. 5 news release. What happened?
A Martinsville, Va.-based physician, who was found guilty of more than 450 counts of multiple drug charges in December, was sentenced to 40 years in prison, the Justice Department said in a Sept. 3 news release. What happened?
An Oakton, Va.-based physician sentenced to 13 years in prison for illegally prescribing opioids and amphetamines has been ordered to forfeit a $168,000 money judgment, two real properties, and to pay $169,244 in restitution to three victims, the Justice Department…
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UnitedHealthcare is suing Radiology Partners and its Arizona affiliate, alleging the companies have been gaming the No Surprises Act’s independent dispute resolution process and “funneling millions into the pockets of its private equity owners.” In a complaint filed Aug. 8…
A former Battle Creek, Mich., physician agreed to pay $705,075 to settle controlled substance allegations, the Justice Department announced Aug. 28. What happened?
ASCs continue to play a growing role in outpatient care delivery, but as the sector expands, so do legal and compliance risks. A recent wave of ASC lawsuits highlights three recurring themes: False claims and billing practices Billing compliance lawsuits…
As consolidation pressures mount and insurer contracts squeeze independent practices, some physicians are finding an unlikely ally in employer-built health plans. Carl Schuessler, co-founder and managing principal of Mitigate Partners, joined Becker’s to discuss how these plans could be a…
Seventy-six percent of ASCs now use an EHR system, according to the Ambulatory Surgery Center Association’s July 2025 60-Second Survey. That figure is up from 64% in 2023 and 55% in 2021, marking a 36% increase in four years. The…