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Geisinger pays $1.3M to settle questioned Medicare claims

The Daily Item, August 3, 2011

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.

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