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Surgeon to pay $3.7M to settle fraud claims, whistleblower gets 17%: 4 notes
The owner of two Montana-based vascular surgery centers agreed to pay millions to resolve allegations that he performed and billed for medically unnecessary procedures. -
'Seize the opportunity to market yourself' with price transparency, ASC leaders told
In November, CMS updated hospital price transparency regulation for hospitals with more than 30 beds. -
Mississippi physician to pay $375K to resolve Medicare billing fraud allegations
A Mississippi physician and his practice have agreed to pay $375,000 to resolve allegations of improperly billing Medicare in violation of the False Claims Act, the U.S. Attorney’s Office for the Southern District of Mississippi said Dec. 13. -
Physician, devicemaker to pay $4.2M to resolve kickback claims: 5 details
The owner of an Atlanta-based medical group and his practice will pay millions to resolve kickback allegations brought by a former employed physician, according to a Dec. 8 Justice Department statement. -
Up to 77% of physicians have difficulty advising patients on out-of-pocket costs: 5 findings
Most physicians have difficulty estimating out-of-pocket medication expenses even when they have access to patients' drug and insurance information, according to a study published in November in JAMA Network Open. -
Self-referral whistleblower on physician-owned hospital to receive $3M
A partially physician-owned hospital in Flower Mound, Texas, will pay millions to resolve allegations that it violated Stark Law, and the physician partner who blew the whistle will receive $3 million, according to a Dec. 2 Justice Department news release. -
Anesthesiologists accuse BCBS of North Carolina of using 'strong-arm tactics' & 6 more BCBS updates
The American Society of Anesthesiologists condemned BlueCross BlueShield of North Carolina's alleged abuse of the No Surprises Act to coerce clinicians and practices into network agreements in a Nov. 22 statement shared with Becker's. -
Illinois medical group pays $500K to resolve fraud allegations
Quincy (Ill.) Medical Group will pay $500,000 to settle allegations that it violated the False Claims Act, according to a Nov. 29 report by CBS and ABC affiliate KHQA. -
Pain clinic owner agrees to pay $9M after admitting to billing fraud
The owner of pain management clinics, laboratories and a pharmacy in three states admitted to billing for unnecessary medical services and paying illegal kickbacks. -
4 procedures getting CMS reimbursement boosts at ASCs
CMS is providing increased payments for several new products and procedures, including these four that are intended for spine surgery, cardiology, gynecology and sleep apnea. -
Texas pain physician to pay $523K to settle fraud allegations: 4 notes
Emad Bishai, MD, a pain management physician in The Woodlands, Texas, agreed to pay half a million dollars to resolve allegations he made false statements in a Paycheck Protection Program loan application and submitted false claims, according to the Justice Department. -
CMS issues late $7K ASC payment hike for sleep apnea procedure
One week after CMS finalized the 2022 rules and reimbursement rates, the agency has released an update raising the rate for closed-loop hypoglossal nerve stimulation, a sleep apnea procedure, by more than $7,000, according to a Nov. 10 news release on a LinkedIn post by Inspire Medical Systems. -
CMS to reimburse for gynecological procedure at ASCs
CMS has created a new CPT code to describe the procedure associated with the EnPlace system, a minimally invasive meshless approach for pelvic floor fixation. -
UnitedHealthcare vs Anthem, Cigna in Q3: 9 notes
Here's how the three largest health insurers by revenue fared in the third quarter: -
The 255 ASC surgeries moved off the ASC payable list by CMS
The 2022 Hospital Outpatient Prospective Payment System and ASC Payment System finalized Nov. 2 removes 255 procedures from the ASC payable list. -
Will commercial insurers follow CMS to move ASC surgeries back to the hospital?
CMS finalized the 2022 ASC payment rules and approved procedures list on Nov. 2, with 255 procedures removed from the outpatient surgery list. -
Payers increasingly trying to avoid correct reimbursement, administrator says
ASCs are recognized by many payers as high-quality, cost-effective sites of service, but some centers are still struggling to secure reimbursements. -
2 ASCs added to program providing free total joint, bariatric surgeries
The 32BJ Health Fund, the health benefits organization for a service workers' union branch, and the New York City-based Mount Sinai Health System expanded their Centers of Excellence program to include two ASCs, according to a Nov. 1 news release. -
ASC's obstacles with private payers
Nine ASC leaders spoke with Becker's ASC Review about the biggest obstacles they face with private payers, from implant costs to declining reimbursements. -
ASC to lower employer work comp costs with bundled payment deal
Ambulatory Surgical Center of Stevens Point (Wis.) is teaming up with Trilogy Health for workers compensation cost containment, the company said Oct. 26.
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