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Geisinger to Pay $18.5M For Hospice Care Billing Violations

Analysis  |  By John Commins  
   November 02, 2021

After the violations were discovered, Geisinger Community Health Services told the United States Attorney's Office.

Geisinger Community Health Services will pay the federal government $18.5 million to resolve self-disclosed violations of Medicare billing rules for hospice and home-based care, the Department of Justice announced.

According to the voluntary disclosures, between January 2012 and December 2017, Danville, Pennsylvania-based GCHS affiliates submitted claims to Medicare for hospice and home health services that violated Medicare rules and regulations regarding physician certifications of terminal illness, patient elections of hospice care, and physician face-to-face encounters with home health patients, DOJ said.

After the violations were discovered, GCHS took corrective action and disclosed the matter to the United States Attorney’s Office.

"The $18 million payment in this matter reflects the priority healthcare providers should place on making sure they closely follow all Medicare rules and regulations," Bruce D. Brandler, acting U.S. Attorney for the Middle District of Pennsylvania, said in a media release.

"Healthcare fraud remains a focus of the Department of Justice and the Affirmative Civil Enforcement Unit of the United States Attorney's Office.  I commend GCHS for taking this seriously, voluntarily disclosing these issues to our office and working to address the problems that led to these violations," he said.

GCHS responds

GCHS issued the following statement:

"As part of a routine self-audit, Geisinger uncovered billing deficiencies related to home health and hospice services from 2012 to 2017. We promptly took corrective action, notified the federal government and cooperated fully with the government leading up to this settlement. Since uncovering these deficiencies, we have conducted follow-up audits that have shown 100 percent compliance, and we do not anticipate any further billing deficiencies related to these services."

“I commend GCHS for taking this seriously, voluntarily disclosing these issues to our office and working to address the problems that led to these violations.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

Photo credit: WASHINGTON, DC - SEPTEMBER 10: Sign for the Department of Justice (DOJ) in Washington, DC on September 10, 2016. By Mark Van Scyoc / Shutterstock


KEY TAKEAWAYS

Between 2012 and 2017 GCHS affiliates submitted claims to Medicare for hospice and home health services that violated Medicare rules.

Specifically, the violations dealt with physician certifications of terminal illness, patient elections of hospice care, and physician face-to-face encounters with home health patients.

After the violations were discovered, GCHS took corrective action and disclosed the matter to the United States Attorney’s Office.


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