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Northwell Health Agreed to Pay $12.7 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Spinal Procedures that Were Not Provided as Claimed or Medically Unnecessary

After it self-disclosed conduct to OIG, Northwell Health Inc. (Northwell), New York, agreed to pay $12,736,087 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Northwell hospitals submitted claims to Medicare that they knew or should have known did not meet the requirements of Medicare Local Coverage Determination, "Veterbroplasty and Vertebral Augmentation - Percutaneous, L26439," because the supporting documentation for those claims failed to demonstrate: (1) that non-surgical medical treatment typically lasting at least six weeks had failed, or (2) the existence of pathological fracture (including osteoporotic fracture), and not simply a fracture attributable to traumatic causes.

Action Details

  • Date:February 13, 2018
  • Enforcement Types:
    • Provider Self-Disclosures