On April 3, the Senate passed an amended fiscal year 2025 budget resolution in a 52-48 vote, advancing efforts to potentially initiate the reconciliation process — and keeping proposed Medicaid cuts in focus. The resolution brings the Senate and House closer to a unified budget framework and retains a directive for the House Energy and […]
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Beckley, W.V.-based Med-Surg Physician Group and its owner Oluyemisi Sangodeyi, MD, agreed to pay $152,382 to settle allegations they submitted false Medicare and Medicaid claims and falsely certified compliance with program requirements, according to an April 2 news release from the Justice Department. What happened?
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A national sales director from Port Jefferson, N.Y., has pleaded guilty to a scheme involving kickbacks to physicians in exchange for ordering unnecessary brain scans, resulting in $70.6 million in fraudulent Medicare claims, according to an April 2 news release from the Justice Department. What happened?
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Gastroenterology has the highest percentage of block time utilization at ASCs, according to ASC software company HST Pathways’ latest “State of the Industry Report.“ Here’s the percentage of block time used at ASCs, by specialty, in 2024, according to data from 590 ASCs in 47 states:
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Rep. Mark Green, MD, a Republican from Tennessee, reintroduced a bill to Congress that would reform prior authorization requirements, The Hill reported March 27. “As a survivor of both colon and thyroid cancer, I know how critical it is to start treatment as soon as possible,” Dr. Green told the news outlet. “Prior authorization can […]
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Healthcare consultant Gregg Gordon, who launched Surgical Solutions IPA in 2024, recently joined Becker’s to discuss how payers have “historically undervalued the ASC model,” and what it will take to shift that dynamic. Mr. Gordon, who has worked on both the provider and payer sides, said payers often focus narrowly on unit cost and reimbursement […]
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On Feb. 25, President Donald Trump signed an executive order targeted at boosting healthcare price transparency. Here are five other notes on the conversation surrounding price transparency for ASC leaders and physicians under the second Trump administration: 1. The order directs HHS and the Labor and Treasury departments to “rapidly implement and enforce” healthcare price […]
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Lenexa, Mo.-based Minimally Invasive Surgery Hospital has filed a lawsuit against Cigna, alleging the insurer failed to pay $1.34 million in claims, Kansas City Business Journal reported March 27. . What happened? Becker’s has reached out to Cigna and will update this story if more information becomes available.
The post Surgical hospital sues Cigna for $1.34M in claims appeared first on Becker’s ASC.
Prior authorization rates are increasing at ASCs, according to HST Pathways’ latest “State of the Industry Report.” The report surveyed 590 ASCs in 47 states. Here are five more insights to know: 1. In 2024, 46% of cases completed preauthorizations, up from 42% in 2023. 2. Only 24% of cases that required a preauthorization in […]
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A federal jury has convicted a Kentucky physician, among other parties, for his role in a scheme to defraud Medicare and Kentucky Medicaid via Kentucky Addiction Centers, according to a March 26 news release from the Justice Department. What happened? What’s next?
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