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Justice News

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

Wednesday, June 26, 2019

Penn Medicine Agrees to Pay $275,000 to Settle False Claims Act Allegations

Lancaster General Hospital’s Division of Maternal-Fetal Medicine Improperly Billed for Obstetric Ultrasounds

PHILADELPHIA, PA – United States Attorney William McSwain announced today that the Trustees of the University of Pennsylvania Health System (“Penn Medicine”) agreed to settle allegations under the False Claims Act that the Lancaster General Hospital’s division of Maternal Fetal Medicine (LGH-MFM), a component of Penn Medicine, submitted false claims to Medicaid for obstetric ultrasounds.

The government alleges that, from approximately May 1, 2017 through December 31, 2017, LGH-MFM had insufficient physician staff to properly handle its patient volume. As a consequence, the government alleges that during this period, LGH-MFM physicians failed to timely complete professional reports interpreting many of the ultrasound studies that they ordered for their obstetric patients. Such a timely report is required for Medicaid to reimburse a physician for professional interpretation of an ultrasound. Further, extreme delays in completing such a report can render the report and interpretation worthless.

Specifically, the government alleges that in many instances, LGH-MFM physicians did not finalize professional reports of ultrasound studies until more than thirty days after the ultrasound was performed. In over 10% of cases during this time period, the report was not completed until more than 90 days after the ultrasound was performed, and in some cases not until after the patient delivered. The government alleges that LGH-MFM violated the False Claims Act by nevertheless submitting claims for reimbursement to Medicaid for ultrasound interpretations when it knew or should have known the claims were not reimbursable due to the extreme delays in completing the physician’s reports.

“Maternal-fetal medicine physicians manage the most high risk and complex pregnancies,” said U.S. Attorney McSwain. “This alleged conduct not only demonstrated an abuse of the Medicaid program, but had troubling potential implications for patient care. Medicaid beneficiaries, especially expectant mothers carrying high risk pregnancies, deserve better. We thank the citizens who brought this concerning situation to our attention.”

“Timely report writing is important for patient care and the proper billing of Medicaid,” said Maureen R. Dixon, Special Agent in Charge of the Philadelphia Regional Office of the Inspector General, Department of Health and Human Services. “HHS-OIG is committed to working with the U.S. Attorney’s Office, our law enforcement partners, and the public to ensure the integrity of federal health care dollars.”

The U.S. Attorney’s Office opened this investigation in response to a tip from citizens. This case was not brought pursuant to the qui tam provisions of the False Claims Act

This case was investigated by the U.S. Department of Health and Human Services Office of the Inspector General. For the U.S. Attorney’s Office, the investigation and settlement were handled by Assistant U.S. Attorney John T. Crutchlow and Auditor Dawn Wiggins.

False Claims Act
UNITED STATES ATTORNEY’S OFFICE EASTERN DISTRICT OF PENNSYLVANIA Suite 1250, 615 Chestnut Street Philadelphia, PA 19106 JENNIFER CRANDALL Media Contact 215-861-8300 If you have not done so already, follow @USAO_EDPA and @USAttyMcSwain to get the most up-to-date information about big cases and community news.
Updated June 26, 2019