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McBride Orthopedic Hospital Agreed to Pay $414,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Upcoded Claims and Claims for Services Provided Without Proper Supervision

After it self-disclosed conduct to OIG, McBride Clinic Orthopedic Hospital, LLC d/b/a McBride Orthopedic Hospital (McBride), Oklahoma, agreed to pay $414,649.91 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that McBride improperly submitted claims to Federal health care programs for: (1) professional services related to surgeries performed by two employee-physicians improperly appended by Modifier 51, 58, and/or 59; (2) professional and facility fees related to post-surgical patient visits performed by a licensed practical nurse without physician supervision; and (3) evaluation and management services performed by an employee-physician during office visits improperly appended by Modifier 25 and/or billed as split/shared. OIG further alleged that McBride knew of overpayments and did not report and return those overpayments in accordance with Medicare rules. Specifically, OIG alleged that McBride allowed the accrual of overpayments owed to Medicare and, when McBride became aware of these overpayments through educational audits, it failed to return those overpayments to Medicare.

Action Details

  • Date:November 1, 2018
  • Enforcement Types:
    • Provider Self-Disclosures