Frederick Oncology and Hematology Associates, PC, a former medical practice located in Frederick, Maryland, have paid the United States $850,949 to settle allegations that Frederick Oncology and Hematology Associates, PC (“FOHA”) submitted inappropriate claims to the United States for evaluation and management services. According to the settlement agreement, from January 1, 2013, to November 1, 2017, FOHA improperly submitted claims for evaluation and management using a code modifier that is only appropriate when there is a separate and distinct evaluation and management service on the same day as a procedure or other service being performed on a patient. FOHA submitted and was paid for those improperly billed claims when FOHA did not perform a separate and distinct evaluation and management. Additionally, FOHA improperly submitted claims from January 1, 2013, to November 1, 2017, under the billing number of the patient’s physician rather than the non-physician provider who treated the patient in the physician’s temporary absence.
The civil settlement reached by the US Attorney’s Office for the District of Maryland arose from an initiative inside the US Attorney’s Office, which involves the use of dedicated resources and personnel to review Medicare billing data. The review of that data has enabled the United States Attorney’s Office to identify areas of concern where it appears that billing irregularities may have taken place. Partnering with the effected agencies, the United States Attorney’s Office has developed the ability to investigate these billing irregularities.
