Pennsylvania Hospital Self-discloses Medicare Billing Violations

A critical access hospital and UPMC affiliate in rural northcentral Pennsylvania settles allegations arising from two self-disclosed Medicare billing irregularities.

Charles Cole Memorial Hospital, a not-for-profit, critical access hospital in Coudersport, Pennsylvania, will pay the federal government $373,547 to settle self-reported irregularities in its Medicare billings.

According to the Department of Justice:

• Cole Memorial "failed to bill under a particular modifier to reduce the Medicare reimbursement amount for services provided by physician assistants and nurse practitioners in its pain management, orthopedics, gastroenterology, and medical oncology physician office practices." The alleged infractions occurred between 2007 and 2013.
   
• A second self-disclosure found that Cole Memorial failed to perform face-to-face encounters with some of its Medicare hospice patients prior to the third benefit period recertification and every subsequent benefit period re-certification from 2001 through early 2014.
   
• Cole Memorial has taken corrective action and voluntarily disclosed the violations, and the payment resolves the case without litigation.

The hospital is located about 170 miles northeast of Pittsburgh. The violations occurred and were self-reported before Cole Memorial affiliated with UPMC in March.