Cedars-SinaiMedicalCenter in Cedars, Calif., has agreed to pay $872,925 in a civil money penalty after it disclosed non-compliant billing practices of a single thoracic surgeon to HHS' Office of Inspector General.
After performing its own investigation, OIG alleges that Cedars-Sinai submitted claims to Medicare and Medicaid on behalf of a single physician for inpatient and outpatient services that weren't provided as charged or weren't supported by documentation for the level of service billed.
The billing errors occurred Dec. 8, 2010, through Feb. 28, 2015, according to OIG.
Cedars-Sinai began its internal investigation into the thoracic surgeon after an employee alerted the corporate integrity department to a suspicious change in a patient's medical record. After the hospital reviewed multiple years of the physician's billing records, it determined the physician's billing documentation was "generally unreliable." Cedars-Sinai disclosed the findings of its internal investigation to the OIG.
In light of the thoracic surgeon's errors, Cedars-Sinai officials said the hospital has strengthened its internal monitoring practices and contracted with a third-party company to conduct coding and documentation audits for each employed physician.