A New Jersey pathology practice will pay $2.4 million to resolve allegations that it violated the False Claims Act by making false representations in connection with submissions to the Centers for Medicare & Medicaid Services (CMS). According to the government’s contentions in the settlement agreement: Princeton Pathology Services P.A. submitted claims to Medicare under Current Procedural Terminology (CPT) code 85390-26 from Jan. 1, 2015, through Dec. 31, 2020. This CPT code requires written analysis by a pathologist, but Princeton Pathology submitted claims using this code without written substantiation in medical records. As a result, Princeton Pathology billed Medicare for analysis of tests that did not require analysis, causing Medicare to significantly overpay. Contemporaneous with the civil settlement, Princeton Pathology also entered into a three-year Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), which requires, among other things, training, auditing, and monitoring designed to address the conduct at issue in the case as well as evolving compliance risks on an ongoing basis.
