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Justice News

Department of Justice
U.S. Attorney’s Office
Middle District of Pennsylvania

Wednesday, April 3, 2013

Easton Hospital Agrees To Pay Government $454,866

To Resolve Allegation Of Improper Medicare Claims

     The United States Attorney's Office for the Middle District of Pennsylvania announced that Easton Hospital has agreed to pay the United States $454,866 to resolve allegations that it submitted improper claims to the Medicare program.  Easton Hospital is a subsidiary of Community Health Systems and is located in Easton, Pennsylvania. 

     According to United States Attorney Peter J. Smith, Easton Hospital has agreed to pay $454,866 to resolve allegations that from January 1, 2004, through May 28, 2009, Easton Hospital improperly submitted claims to the Medicare program for payment that contained evaluation and management services that were not allowable under Medicare.

     Medicare does not normally allow additional payments for such services performed by a provider on the same day as a procedure, unless the service is significant, separately identifiable, and above and beyond the usual preoperative and postoperative care associated with the procedure.  In such cases, an attachment to the claim, known as "Modifier 25," may be submitted to allow the additional payment.

     In this matter, the government determined that Easton Hospital incorrectly attached Modifier 25 to Medicare claims that led Medicare to pay the hospital for evaluation and management services that were not significant and separately identifiable from the underlying procedure for which Medicare also paid the hospital.

     The U.S. Attorney’s Office acknowledged and Easton Hospital’s cooperation and remedial action which helped to resolve the matter.  After the Government contacted Easton Hospital concerning improper Modifier 25 claims, the hospital conducted an internal review to determine what caused the improper claims to be submitted to the Medicare program and took action to increase medical coding training and bolster its compliance program.  

     The Harrisburg Office of the U.S. Attorney’s Office had jurisdiction because Medicare provider claims are processed by Novitas Solutions, Inc., formerly Highmark Medicare Services, in Camp Hill, Pennsylvania.  The U.S. Attorney’s Office for the Eastern District of Pennsylvania cooperated in this matter.

     The case was investigated by the U.S. Department of Health and Human Services, Office of the Inspector General, in Harrisburg and handled by D. Brian Simpson, of the United States Attorney's Office, Civil Division.

Updated April 9, 2015