News and Press Releases

Divine Providence Hospital Agrees to Pay Government Almost $600,000 to Resolve Allegation of Improper Medicare Claims

June 14, 2011

     The United States Attorney's Office for the Middle District of Pennsylvania announced that a Williamsport area hospital has agreed to pay the United States $598,965 to resolve allegations that it erroneously submitted improper claims to the Medicare program.

     According to United States Attorney Peter J. Smith, Divine Providence Hospital has agreed to pay $598,965 to resolve allegations that from January 1, 2004, through December 31, 2007, the hospital erroneously submitted claims to the Medicare program for payment that contained evaluation and management services that were not allowable under Medicare.

     U.S. Attorney Smith noted that Medicare does not normally allow additional payments for evaluation and management services performed by a provider on the same day as a procedure.

     If a provider performs an evaluation and management service on the same day as a procedure and the service is significant, separately identifiable, and above and beyond the usual preoperative and postoperative care associated with the procedure, an attachment to the claim, known as "Modifier 25," may be submitted to allow additional payment for the separate evaluation and management service.

     In this matter, the government determined that Divine Providence 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.

     U.S. Attorney Smith credited the hospital for its cooperation and corrective action which helped to resolve the matter fairly and efficiently.

     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.


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