Penn State Health (PSH) has agreed to pay $1.252 million to settle allegations that two of its hospitals submitted claims for evaluation and management (E/M) services and infusion services on the same date of service in violation of Medicare rules, the U.S. Attorney’s Office for the Middle District of Pennsylvania said March 7.^[1] The settlement stemmed from PSH’s self-disclosure.

The government alleged that Milton S. Hershey Medical Center billed Medicare Part B for E/M services that weren’t supported by medical records on the same day as infusion between January 2015 and March 2019, according to the settlement.^[2] The same thing happened with St. Joseph Medical Center between July 2015 and June 30, 2018.

“This issue was about technical, not clinical, billing for evaluation and management (E&M) services rendered on the same day as infusion services at Penn State Health Milton S. Hershey Medical Center and at St. Joseph Medical Center in Reading,” PSH said in a statement. “It did not involve the quality of clinical care. The technical component of a service (or bill) covers the fees for the room, equipment, supplies and non-physician work. The services at issue were medically necessary and were correctly furnished to patients. Once the billing error was identified, we immediately took measures to correct our billing. We self-reported the error to the United States Attorney’s Office, fully cooperated with the government during its review and repaid the amounts to Medicare and other federal health care payers, so the matter is now settled. We have taken steps to prevent this from happening in the future.”