Wednesday, August 23, 2017
Baltimore, Maryland – St. Agnes Healthcare has agreed to pay the United States $122,928 to resolve claims under the False Claims Act alleging that St. Agnes submitted false claims to Medicare by billing for evaluation and management (E&M) services at a higher reimbursement rate than the Federal health care programs allowed.
The settlement agreement was announced today by Acting United States Attorney for the District of Maryland Stephen M. Schenning and Special Agent in Charge Nick DiGuilio of the Office of Inspector General for the Department of Health and Human Services.
In June 2011, St. Agnes acquired a medical practice consisting of twelve cardiologists who were formerly members of MidAtlantic Cardiovascular Associates. The twelve cardiologists became employees of St. Agnes and continued to provide services to their patients through Maryland Cardiovascular Specialists, a specialty practice affiliated with St. Agnes. Medicare permits a higher rate of reimbursement for E&M services provided to new patients as opposed to E&M services provided to established patients. A new patient is defined as a patient who has not received any professional services from the physician or physician group practice within the previous three years.
According to the settlement agreement, the United States contends that for E&M services rendered from June 3, 2011 through June 3, 2014 by the twelve cardiologists who became St. Agnes’ employees, St. Agnes improperly submitted or caused to be submitted claims to Medicare using CPT codes 99201-99205 (new patient E&M codes) when CPT codes 99211-99215 (existing patient E&M codes) should have been used. By using the new patient codes as opposed to the existing patient codes, St. Agnes improperly received more reimbursement than it was entitled to under Medicare.
The civil settlement resolves a lawsuit filed under the whistleblower provision of the False Claims Act by Jonathan Safren, a former cardiologist employed by St. Agnes (United States ex rel Jonathan Safren v. St. Agnes Healthcare., Case No. ELH-16-2537 (D. Md.)). The False Claims Act permits private parties to file suit on behalf of the United States for false claims and obtain a portion of the government’s recovery. As part of today’s resolution, Dr. Safren will receive $20,000. The claims resolved by this settlement are allegations only, and there has been no determination of liability.
Acting United States Attorney Stephen M. Schenning commended the Inspector General of the Department of Health and Human Services and thanked Assistant U.S. Attorneys Thomas Corcoran and Jane Andersen who handled the case.
Contact ELIZABETH MORSE at (410) 209-4885