The United States Attorney’s Office for the Middle District of Pennsylvania announced that Penn State Health (PSH) has agreed to pay $1,252,662.28 to resolve allegations of civil liability for submitting claims to Medicare for Evaluation & Management (E&M) services that violated Medicare rules and regulations.
According to U.S. Attorney Gerard M. Karam, Penn State Health voluntarily disclosed that, between January 2015 and March 2019 for HMC, and between July 2015 and June 2018 for SJMC, PSH submitted claims to Medicare Part B for E&M services that were not supported by the medical record on the same date of service as infusion services.
After it discovered the problems, PSH took prompt corrective action, Karam said.
A spokesperson with Penn State Health provided the following statement:
"We discovered through our own internal processes that our documentation was not aligned with Medicare’s technical billing requirements. This issue was about technical, not clinical, billing for evaluation and management (E&M) services rendered on the same day as infusion services at Penn State Health Milton S. Hershey Medical Center and at St. Joseph Medical Center in Reading. It did not involve the quality of clinical care.
"The technical component of a service (or bill) covers the fees for the room, equipment, supplies and non-physician work. The services at issue were medically necessary and were correctly furnished to patients. Once the billing error was identified, we immediately took measures to correct our billing. We self-reported the error to the United States Attorney’s Office, fully cooperated with the government during its review and repaid the amounts to Medicare and other federal health care payers, so the matter is now settled.
We have taken steps to prevent this from happening in the future."
The matter was handled by the Department of Health and Human Services (HHS), Office of Counsel to the Inspector General (OCIG), and Assistant U.S. Attorney Tamara Haken of the Affirmative Civil Enforcement Unit of the U.S. Attorney’s Office for the Middle District of Pennsylvania.
