DANVILLE - Geisinger Medical Center in Danville has agreed to pay the U.S. government $1.3 million to resolve allegations that it incorrectly billed Medicare, the U.S. Attorney's Office for the Middle District of Pennsylvania announced Tuesday.
According to U.S. Attorney Peter J. Smith, the government contends that from Jan. 1, 2001, through Dec. 31, 2006, Geisinger submitted claims to Medicare for payment for services that were not allowable under Medicare program's requirements.
Geisinger agreed to pay $1.3 million while not admitting liability or accepting the government's contentions "to avoid the delay, uncertainty, inconvenience and expense of litigation," according to the U.S. Attorney's Office.
Geisinger Health System is a major provider of care to Medicare recipients and the amount to be refunded represents only .138 percent of the health system's total Medicare billings for the time period in question, according to a press release from Geisinger.
"The issue concerns interpretation of what is known as Modifier 25, which enables providers to bill for additional payment for a separate medical evaluation and treatment," said Geisinger Medical Center Chief Administrative Officer Thomas Sokola. "Medical coding principles are very complex and technical in nature. As such, there are significant differences of opinion among coding professionals as to the correct criteria relating to Modifier 25 billings."
According to Smith, the government considered the matter appropriate for a settlement without filing suit under the False Claims Act because most of the claims in question were filed prior to 2005 and because Geisinger amended its billing practices before being contacted by the U.S. Attorney's Office and had voluntarily refunded more than $510,000 in overpayments it received for other unrelated services.
"This is an ordinary repayment that does occur occasionally given our commitment to continuous oversight and billing compliance," Sokola said. "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."
Geisinger's compliance program includes ongoing reviews of medical coding to ensure proper billing. In connection with this matter, Geisinger retained independent coding experts who concluded that the health system's staff had made reasonable determination that the medical center was entitled to payment on many of the claims, according to the Geisinger press release.
The matter was investigated by the U.S. Department of Health and Human Services, Office of the Inspector General in Harrisburg and handled by D. Brian Simpson of the U.S. Attorney's Office Civil Division as part of the office's Health Care Program Initiative.