Lancaster General operators to pay $275K over claims of improper billing

Lancaster

LANCASTER, Pa. (WHTM) – Penn Medicine, the operators of Lancaster General Hospital, has agreed to pay $275,000 to settle claims the hospital’s maternal-fetal medicine division submitted false claims to Medicaid, federal prosecutors said Wednesday.

The U.S. Attorney’s office for the Eastern District of Pennsylvania alleges that from May to December of 2017, the division had insufficient physician staff to properly handle its patient volume and therefore failed to complete reports for many ultrasound studies they ordered for patients.

In many instances, physicians did not finalize reports of ultrasound studies until more than 30 days later. In over 10% of cases, it took more than 90 days to complete the reports, and some were not finished until after the patient delivered, U.S. Attorney Willaim McSwain’s office said.

Timely reports are required for Medicaid to reimburse a physician for an ultrasound interpretation. Lancaster General’s maternity division violated the False Claims Act by submitting claims for reimbursement when it knew or should have known the claims were not reimbursable due to the extreme delays, prosecutors said.

“Maternal-fetal medicine physicians manage the most high risk and complex pregnancies,” McSwain said in a statement. “This alleged conduct not only demonstrated an abuse of the Medicaid program but had troubling potential implications for patient care.”

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