Category: ASC Coding, Billing and Collections

From Stark law violations to the overturning legal precedents, several significant legal developments occurred within healthcare fraud enforcement in the third quarter of 2024. 

A federal judge in Florida has dismissed a whistleblower lawsuit accusing a medical practice of inflating Medicare reimbursements, citing constitutional concerns over the False Claims Act’s qui tam provisions, law.com reported Oct. 4. 

Denials of claims are increasing, along with the administrative burden of managing them, according to Experian Health’s “2024 State of Claims” survey. 

Migrating procedures to the ASC setting has the potential to save patients, payers and healthcare money.

Stark law has evolved into a complex framework that continues to challenge physicians, and as regulatory changes and enforcement actions escalate, leaders are grappling with how best to comply with these laws. 

Nearly 75% of providers report an increase in claim denials, a 31% jump since 2022, according to the Experian Health’s “2024 State of Claims” survey. 

The future of Stark law is “clouded by uncertainty” after a district court ruled that a false claims lawsuit filed against Thomas Health System cannot be resolved without parties’ briefs on the U.S. Supreme Court’s recent overturning of the Chevron def…

The U.S. House Sept. 23 has unanimously passed a bill allowing mail delivery of prescription drugs to Medicare patients.

On Sept. 24, CMS issued a final ruling to address “significant, anomalous and highly suspect” billing activity on the Medicare Shared Savings program to mitigate financial impacts for Accountable Care Organizations. 

Commercial and government payers alike are increasingly pushing patients to ASCs because of the cost-savings they can offer.