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Penn State Health To Pay $1.2M Penalty For Medicare Claims Violations

Analysis  |  By Amanda Schiavo  
   March 15, 2023

Penn State Health is said to have discovered the issue and self-reported it to the U.S. Attorney’s Office.

Penn State Health, a Hershey, Pennsylvania-based healthcare provider with over $400 million in total revenue, has agreed to pay a penalty of $1.2 million to settle allegations the organization submitted claims to Medicare for Evaluation and Management services that violated Medicare rules and regulations. 

Penn State Health voluntarily disclosed that, between January 2015 and March 2019 for HMC, and between July 2015 and June 2018 for SJMC, PSH submitted claims to Medicare Part B for E&M services that were not supported by the medical record on the same date of service as infusion services, according to U.S. Attorney Gerard Karam.

"After it discovered the problems, PSH took prompt corrective action," the U.S. Attorney’s Office for the Middle District of Pennsylvania said in a statement.

"We discovered through our own internal processes that our documentation was not aligned with Medicare’s technical billing requirements," Penn State Health said in a statement, according to "This issue was about technical, not clinical, billing for evaluation and management services rendered on the same day as infusion services at Penn State Health Milton S. Hershey Medical Center and at St. Joseph Medical Center in Reading. It did not involve the quality of clinical care. The technical component of a service (or bill) covers the fees for the room, equipment, supplies and non-physician work. The services at issue were medically necessary and were correctly furnished to patients"

Amanda Schiavo is the Finance Editor for HealthLeaders.

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