DANVILLE – Geisinger Medical Center has agreed to pay the federal government $1.3 million to settle allegations that it erroneously submitted improper claims to the Medicare program, the U.S. Attorney’s office announced this morning.
Geisinger erroneously submitted claims for payment that contained evaluation and management services that were not allowed under Medicare program requirements, said Peter J. Smith, the U.S. Attorney for the Middle District of Pennsylvania.
Medicare does not normally allow additional payments for evaluation and management services by a provider on the same day as a medical procedure is performed, Smith said.
These services – known as “Modifier 25” – may be submitted as part of claims to Medicare only when they are separately identifiable and above and beyond the usual care associated with a particular procedure, government officials said.
In this case, the federal government “determined that Geisinger incorrectly attached Modifier 25 to claims that led Medicare to pay the hospital funds to which Geisinger was not entitled,” Smith wrote in a statement.
In a prepared statement, Geisinger administrators said the $1.3 million refunded represented 0.138 percent of the company’s total Medicare billings for 2001 to 2006.
Calculated out, this would put their Medicare claims for 2001 to 2006 at approximately $940 million.
“This is an ordinary repayment that does occur occasionally given our commitment to continuous oversight and billing compliance,” said GMC Chief Administrative Officer Thomas Sokola in the press statement.
“Geisinger invests millions of dollars in resources and staff to focus entirely on compliance, and we have voluntarily made corrections and issued refunds as necessary over the years.”
Both Geisinger and the Department of Justice noted that the hospital had voluntarily refunded more than $510,000 in overpayments in the past and that Geisinger had changed their billing practice before being contacted by the government.
Geisinger said the error was identified by a self-monitoring program implemented by the hospital.
Under an agreement with the government, Geisinger will pay $1.3 million while not admitting liability or accepting the government’s contentions “to avoid the delay, uncertainty, inconvenience and expense of litigation.”
Smith said the government agreed to the settlement because most of the claims were filed before 2005, because Geisinger amended its billing practices before being contacted by the U.S. Attorney’s office, and because it voluntarily refunded more than $510,000 in overpayments it received for other unrelated services.
The case was investigated by the U.S. Department of Health and Human Services, the office of the Inspector General in Harrisburg and was handled by D. Brian Simpson of the U.S. Attorney’s Civil Division, part of the office’s Health Care Program Initiative.