In 2024, seven major Stark law indictments contributed to a record-breaking 979 qui tam lawsuits, with False Claims Act settlements and judgments totaling $2.92 billion by the federal government’s fiscal year-end. The enforcement wave was built across five years of…
ASC Coding, Billing & Collections
A Louisiana nurse practitioner who authored books on Medicare regulations has been sentenced to 87 months in prison for causing more than $12 million in fraudulent Medicare claims for medically unnecessary cancer genetic tests, the Justice Department said in a…
The Centers for Medicare and Medicaid Services added 573 procedures to the ASC covered procedures list for 2026 — 302 newly approved codes and 271 coming off the inpatient-only list. For the Ambulatory Surgery Center Association, which spent years in…
Increasing price transparency at hospitals and healthcare organizations has been a priority for President Donald Trump’s as his administration seeks to increase clarity for patients surrounding what they will actually pay for for services. While federal price transparency laws have…
Nationally, roughly 1% of U.S. physicians have opted out of Medicare entirely, according to 2025 data from KFF. While 1% appears to be a marginal number upon first glance, a closer look at where those exits are happening, and what…
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The No Surprises Act was designed to protect patients from unexpected medical bills, but it has also created a complex administrative network that some leaders believe burdens independent practices. Eric Haas, MD, chief medical officer of the American Academy of…
A federal judge in Chicago has denied class certification in an antitrust lawsuit brought by former employees of SCA Health, DaVita and United Surgical Partners International alleging a no-poach agreement suppressed wages among senior outpatient clinic employees, according to a…
Most surgical practices treat network participation as a prerequisite for building volume, staying busy and keeping the lights on. But Anthony Maioriello, MD, challenged that assumption at Becker’s Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference…
It is often said that the operating room minute is the most expensive unit of time in healthcare — but that doesn’t mean it’s necessarily central to ASC profit margins. Michael Verdon, DO, a neurosurgeon and chief medical officer at…
Mark Cuban disrupted pharmaceutical pricing in 2022 with Cost Plus Drugs, a public benefit corporation that charges a flat 15% markup on generics and posts its full price list publicly, bypassing pharmacy benefit managers and intermediaries entirely. Four years later,…