Site-neutral payment reforms have been under close watch by ASC leaders over the last several years as the industry continues to advocate for financial parity with HOPDs. CMS’ 2026 Hospital Outpatient Prospective Payment System rule advances a major step toward…
ASC Coding, Billing & Collections
In the largest Medicare Advantage fraud settlement to date, Oakland, Calif.-based Kaiser Permanente agreed to pay $556 million to resolve allegations it violated the False Claims Act by submitting unsupported diagnosis codes to Medicare Advantage. The government alleged the scheme…
Elisa Auguste, administrator at East Setauket, N.Y.-based Precision Care Surgery Center and vice president of the New York State Association of ASCs, joined Becker’s to discuss how deeper collaboration between payers, providers and ASCs could improve the prior authorization process…
The Department of Justice announced Jan. 12 that False Claims Act settlements in 2025 exceeded $6.8 billion—the highest annual total in the history of the statute. In a Jan. 26 report, JD Supra outlines four other key takeaways from the…
Medical malpractice verdicts topping $10 million — often dubbed “nuclear” awards — are becoming more common as juries hand down eye-popping damages for catastrophic injuries and wrongful deaths. Physician groups, including the American Medical Association, have warned that the post-COVID-19…
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Brian August, MD, a physician in El Paso, Texas, has agreed to pay $200,000 to resolve allegations that he violated the Controlled Substances Act, the False Claims Act and the Texas Health Care Program Fraud Prevention Act. According to a…
As payer prior authorization requirements grow more complex, ASCs are increasingly caught in what one administrator describes as a “game of chicken” between patient care and financial survival. Elisa Auguste, administrator at East Setauket, N.Y.-based Precision Care Surgery Center and…
A former Saginaw, Mich., physician will be tried on 23 counts of Medicare fraud and false claims, according to a Jan. 22 news release from the Michigan Attorney General. What happened?
Denials, audits and delayed payments are accelerating across ASC, and leaders say payer behavior has become more aggressive, automated and less collaborative over the past year. Five ASC executives joined Becker’s to discuss how they’re adapting, from tightening documentation and…
As employers push patients to lower-cost sites of care and regulators nudge providers toward downside risk, value-based care is moving from theory to reality, and it is coming at “lightning speed,” according to Dan Tasset, founder and chairman of Leawood,…