This is a column by Les Jebson, administrator of the Orthopedics and Sports Medicine Network at Prisma Health. The presence of medical device representatives in surgical settings has become increasingly common in modern healthcare, particularly as procedures grow more technologically…
ASC Coding, Billing & Collections
Three Colorado Springs, Colo.-based healthcare companies and two individuals face False Claims Act allegations of submitting tens of thousands of fraudulent claims to Medicare and Tricare using a deceased physician’s provider number to obtain higher reimbursement rates, the Justice Department…
A North Carolina pharmaceutical company has agreed to pay more than $46 million to resolve criminal and civil allegations of paying kickbacks to physicians and pharmacies to induce prescriptions of its kidney transplant immunosuppression drug, including the largest Sunshine Act…
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…
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…
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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…
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…