St. Luke's University Health Network in Bethlehem, Pa., and Easton (Pa.) Hospital will pay nearly $1.5 million to resolve allegations they improperly overbilled Medicare, according to a Morning Call report.
St. Luke's will pay approximately $1.03 million to resolve the allegations, while Easton Hospital will pay approximately $455,000.
St. Luke's allegedly overbilled Medicare from 2002 through 2012 for evaluation and management services that were not billable under Medicare regulations. Easton Hospital faced similar allegations from 2004 through 2009.
The allegations specifically pertain to a claim called "modifier 25," which is to be used for same-day services for a patient only when the service is "significant, separately identifiable and above and beyond the usual preoperative and postoperative care associated with the procedure," according to the report.
In a statement, St. Luke's said its alleged overbilling was the result of "significant confusion ... as to when a modifier 25 should be used."
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St. Luke's will pay approximately $1.03 million to resolve the allegations, while Easton Hospital will pay approximately $455,000.
St. Luke's allegedly overbilled Medicare from 2002 through 2012 for evaluation and management services that were not billable under Medicare regulations. Easton Hospital faced similar allegations from 2004 through 2009.
The allegations specifically pertain to a claim called "modifier 25," which is to be used for same-day services for a patient only when the service is "significant, separately identifiable and above and beyond the usual preoperative and postoperative care associated with the procedure," according to the report.
In a statement, St. Luke's said its alleged overbilling was the result of "significant confusion ... as to when a modifier 25 should be used."
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