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Memorial Herman Health System Agreed to Pay $6.4 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Upcoded Evaluation and Management Claims

After it self-disclosed conduct to OIG, Memorial Herman Health System (MHHS), Texas, agreed to pay $6,413,851.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that MHHS improperly submitted claims where MHHS: (1) automatically appended a 99201 or G0453 facility Evaluation and Management (E/M) Current Procedural Terminology code to preoperative assessments performed by nurses in a hospital setting; and/or (2) automatically appended a modifier 25 to certain E/M services billed on the same day as a surgical procedure.

Action Details

  • Date:September 6, 2019
  • Enforcement Types:
    • Fraud Self-Disclosures