Fenton Nelson is the law firm for healthcare professionals, facilities and businesses.

The Departments of Justice and Health and Human Services  provided Congress with their joint  “Health Care Fraud and Abuse Control Program Annual Report” outlining the healthcare fraud prevention and enforcement activities of both departments over the last fiscal year.   

This article provides an overview of the recent lawsuit filed by Aetna against Bay Area Surgical Management LLC, alleging the surgery centers illegally induced its physician investors to refer their patients to the surgery centers with promises that the patients would not have any financial responsibility to the surgery centers for their out-of-network coinsurance and deductibles. 

This is a hot topic for ASC’s as they should be concerned that health insurers might use aggressive litigation tactics to challenge any type of discount arrangement that the insurer does not like, even if it is designed simply to avoid the unsavory process of sending patients to collections.

Physicians Need to Get Ready for the Overhaul of the Diagnostic Coding System