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Penn State Health to pay $1.2 million to resolve potential liability for improper Medicare claims
Centre Daily Times - 3/7/2023
Mar. 7—Penn State Health agreed to pay more than $1.2 million to avoid potential liability for improperly submitting Medicare claims, the U.S. Attorney's Office for the Middle District of Pennsylvania wrote in a statement Tuesday.
The health care system voluntarily disclosed it submitted claims to Medicare Part B for evaluation and management services that were not supported by the medical record on the same date of service as infusion services, U.S. Attorney Gerard M. Karam said in the statement.
The improper claims were submitted between January 2015 and March 2019 for Penn State Health Milton S. Hershey Medical Center in Dauphin County and between July 2015 and June 2018 for Penn State Health St. Joseph Medical Center in Berks County.
More than $835,000 of the settlement was restitution. Penn State Health has to pay the full amount within 30 days of Feb. 28.
Penn State Health took "prompt corrective action" after the violations were discovered, Karam said.
The health system discovered its documentation was not aligned with Medicare's technical billing requirements. The issue, the health system wrote in a statement, was about technical billing. It did not involve the quality of clinical care.
The technical component of a 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, the health system said.
"Once the billing error was identified, we immediately took measures to correct our billing," the health system said. "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."
This story was originally published March 7, 2023, 1:04 PM.
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