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Franciscan Medical Center Agreed to Pay $219,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Psychotherapy Services that Were Not Covered or Not Provided as Claimed

After it self-disclosed conduct to OIG, Mayo Clinic Health System - Franciscan Medical Center, Inc. (Mayo Clinic), Wisconsin, agreed to pay $219,357.82 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Mayo Clinic: (1) submitted claims to Federal health care programs for psychotherapy services allegedly provided by a psychiatrist using blended Current Procedural Terminology (CPT) Code 90805 or 90807, where the services were not billable, or where only Evaluation and Management service CPT Code 99212 or 99213 should have been billed; and (2) submitted claims to Federal health care programs for psychotherapy services allegedly provided by a psychiatrist, and billed each claim using CPT Code 90833, 90836, or 90838, where the services were not billable, or where only CPT Code 99212 or 99213 should have been billed.

Action Details

  • Date:July 21, 2016
  • Enforcement Types:
    • Provider Self-Disclosures