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…
ASC Coding, Billing & Collections
In the back half of July 2026, the Department of Justice brought at least four separate enforcement actions touching ophthalmology within about two weeks, and the cases point to three vulnerabilities baked into how ophthalmology practices generate revenue. Drugmaker EyePoint…
A Jacksonville, Fla.-based Medicare Advantage MSO has agreed to pay $14.1 million to resolve False Claims Act allegations of submitting false diagnosis codes to inflate risk adjustment payments, the Justice Department said in an Aug. 3 news release. Complete Health…
Boston-based Ophthalmic Consultants of Boston has agreed to pay nearly $3.9 million to resolve False Claims Act allegations of improperly billing Medicare and MassHealth for office visits in addition to intravitreal injection procedures, the Justice Department said in a July…
Two New York ophthalmology practices have agreed to pay a combined $2.3 million to resolve False Claims Act allegations of billing Medicare and Medicaid for medically unnecessary transcranial doppler ultrasounds through a kickback arrangement with a third-party testing company, the…
Advertisement
Physicians on RVU-based compensation plans often have no way of knowing whether the rate they are being paid is fair, and according to one gastroenterologist, that is often by design. The structural disconnect of wRVUs is well documented. Provider productivity,…
Payers are escalating public criticism of the No Surprises Act’s arbitration process, arguing the system is being exploited by a small number of providers as disputes and payouts climb to record levels. Health insurance CEOs, an industry coalition and at…
A Houston-based laboratory, its former CEO and a Florida businessman have agreed to pay a combined $36.4 million to resolve False Claims Act allegations of paying kickbacks and billing Medicare and Medicaid for medically unnecessary genetic testing, the Justice Department…
Auto insurance provider Geico has accused two New York physician groups and the physician who owned them of billing the insurer more than $2 million for auto-accident treatments the company says were medically unnecessary or, in many instances, never performed…
Dallas-based Tenet Healthcare executives said they are still modeling how a proposed federal rule reshaping 340B drug reimbursement and hospital outpatient facility fees could affect the company’s ASCs, according to comments on the company’s July 24 second-quarter earnings call. What…