The government alleged that Lancaster (Pa.) General Hospital’s division of maternal fetal medicine lacked enough physicians to properly handle its patient volume from May 1, 2017, through Dec. 31, 2017. During that time, there were allegedly many instances where physicians didn’t finalize reports interpreting ultrasound studies until more than 30 days after the ultrasound was performed. In more than 10 percent of cases, the report was not finalized until more than 90 days after the ultrasound was performed, according to the Justice Department.
Physicians must complete the reports in a timely manner to receive Medicaid reimbursement for interpreting ultrasound studies. The settlement resolves allegations that Lancaster General violated the False Claims Act by submitting claims for ultrasound interpretations to Medicaid when the claims were not reimbursable because of the extreme delays in completing the physician reports.
Penn Medicine entered into the settlement with the government after an investigation by the U.S. Attorney’s Office. The investigation was launched in response to a tip from citizens, according to the Justice Department.
More articles on legal and regulatory issues:
Ex-Iowa hospital CEO charged with theft after auditor’s investigation
HCA fires back in lawsuit over ER ‘cover charge’
Cardiologist convicted in ‘fountain of youth’ billing fraud scam
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
