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Hoag Clinic Agreed to Pay $204,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services that Were Not Medically Necessary or Incorrectly Billed

After it self-disclosed conduct to OIG, Hoag Clinic, California, agreed to pay $204,916.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Hoag Clinic submitted false claims to Medicare, Medicaid, TRICARE, and the Health Resources Services Administration (HRSA) COVID-19 Uninsured Program for services that were billed at a higher level of service than was provided, billed when not medically necessary, billed using the incorrect CPT code, billed when the service was not documented, separately billed when the claim should have been included in the E&M code, billed without the correct modifier, billed for a duplicate tests, or billed for a service without a valid order.

Action Details

  • Date:October 3, 2023
  • Enforcement Types:
    • COVID-19,
    • Fraud Self-Disclosures