A Maryland urology practice agreed last week to pay the Federal government $1.85 million in order to settle allegations that it improperly billed Medicare for evaluation and management (E&M) services.
According to investigators, the company submitted false claims to Medicare for E&M services that were not eligible for reimbursement. They say the practice of separately billing E&M services began in early 2013 and continued for three full years.
Ordinarily E&M services are not eligible for separate billing under Medicare unless the service meets certain criteria, at which point the provider may use the “modifier 25” billing code to identify it as a separate charge. However, investigators say the office routinely used the modifier 25 code for services that did not meet the criteria, allowing it to obtain a greater total compensation from Medicare than it was rightfully entitled.
In addition to paying the fine, the practice has agreed to a three-year monitoring program with the U.S. Department of Health and Human Services, Office of Inspector General in an effort at ensuring proper and legitimate billing practices are carried out going forward.
The suit against the urology practice was brought under the qui tam, or whistleblower, provision of the False Claims Act (a/k/a “Lincoln’s Law”) which allows a whistleblower to bring suit against an alleged wrongdoer which, should the federal government find the claim meritorious, allows federal agencies to step in and prosecute the suit.
Though the practice will pay fines in relation to the allegations, it did not admit to guilt, and no determination of guilt on the charges was made by a court.
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