Geisinger Medical Center Agrees to Pay Government $1.3 Million To Resolve Questioned Medicare Claims


August 2, 2011

The United States Attorney's Office for the Middle District of Pennsylvania announced that the Geisinger Medical Center, Danville, PA, has agreed to pay the United States $1,300,000 to resolve allegations that it erroneously submitted improper claims to the Medicare program.

According to United States Attorney Peter J. Smith, the government contended that from January 1, 2001, through December 31, 2006, Geisinger erroneously submitted claims to the Medicare program for payment that contained evaluation and management services that were not allowable under the Medicare program's requirements.

According to the United States Attorney's Office, Medicare does not normally allow additional payments for evaluation and management services by a provider on the same day as a medical procedure is performed.

Such services, known as "Modifier 25," may be submitted as part of claims to Medicare only when they are separately identifiable and above and beyond the usual care associated with a procedure.

In this matter, the government determined that Geisinger incorrectly attached Modifier 25 to claims that led Medicare to pay the hospital funds to which Geisinger was not entitled. 

As stated in the agreement, the United States Attorney's Office and Geisinger reached a settlement in which Geisinger agreed to pay $1.3 million while not admitting liability or accepting the Government's contentions, "to avoid the delay, uncertainty, inconvenience and expense of litigation."

According to U.S. Attorney Smith, the government considered the matter appropriate for a settlement without filing suit under the False Claims Act because most of the claims in question were filed prior to 2005 and because Geisinger amended its billing practices before being contacted by the United States Attorney's Office and had voluntarily refunded over $510,000 in overpayments it received for other unrelated services.

The matter 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, as part of the Office's Health Care Program Initiative.