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.

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. 

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.

The owner of pain management clinics, laboratories and a pharmacy in three states admitted to billing for unnecessary medical services and paying illegal kickbacks.

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.

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.

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 has created a new CPT code to describe the procedure associated with the EnPlace system, a minimally invasive meshless approach for pelvic floor fixation.

Here's how the three largest health insurers by revenue fared in the third quarter: 

The 2022 Hospital Outpatient Prospective Payment System and ASC Payment System finalized Nov. 2 removes 255 procedures from the ASC payable list.

CMS finalized the 2022 ASC payment rules and approved procedures list on Nov. 2, with 255 procedures removed from the outpatient surgery list.

ASCs are recognized by many payers as high-quality, cost-effective sites of service, but some centers are still struggling to secure reimbursements. 

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.

Nine ASC leaders spoke with Becker's ASC Review about the biggest obstacles they face with private payers, from implant costs to declining reimbursements. 

Ambulatory Surgical Center of Stevens Point (Wis.) is teaming up with Trilogy Health for workers compensation cost containment, the company said Oct. 26. 

The Office of Inspector General found CMS overpaid $636 million for neurostimulator implantation surgeries between 2016 and 2017, according to an audit of outpatient hospital and ASC claims. 

Five updates from Aetna, an insurer serving about 39 million customers nationwide, in the last 60 days:

Springfield (Ill.) Clinic warned 100,000 Blue Cross and Blue Shield of Illinois-covered patients that they could lose access to their doctors, The State Journal-Register reported Oct. 15. 

Melbourne, Fla.-based Surgery Center of Viera sued Aetna on Oct. 13, according to court documents. The lawsuit alleges that Aetna used an undisclosed "mystery repricing program" to reimburse Viera $33,380 for a July 2018 spinal procedure that the ASC says cost $223,988.

Gil Tepper, MD, founder and CEO of Prime Surgeons in Los Angeles, spoke with Becker's ASC Review on changes he feels CMS should implement to give hospital outpatient departments and ASCs equal footing.