Federal rules have required health plans to publicly post their prior authorization requirements and outcomes since CMS finalized its Interoperability and Prior Authorization rule in 2024. But a review by the American Medical Association found that many plans were meeting…
ASC Coding, Billing & Collections
A physician in Waxhaw, N.C., has been sentenced to six months in prison for allowing his Drug Enforcement Administration number to be used for unlawful opioid prescriptions, according to an Aug. 17 news release from the Justice Department. According to…
A North Carolina man and his Texas-based company have been named in a federal civil complaint alleging they billed Medicare for surgical implantation of electro-neurostimulators when the devices were actually temporary, nonsurgical electro-acupuncture devices applied behind patients’ ears, the Justice…
Nearly four decades after Rep. Fortney Stark, D-Calif., first moved to bar physicians from referring Medicare patients to labs they had a financial stake in, Stark law is again the subject of bipartisan bills and trade group lobbying. Here’s what’s…
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…
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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…
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…