Northwell Health and North Shore Long Island Jewish Medical PC Agreed to Pay $981,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Upcoded Evaluation and Management Services

After they self-disclosed conduct to OIG, Northwell Health Inc. (Northwell) and North Shore Long Island Jewish Medical P.C. (North Shore), New York, agreed to pay $981,679 for allegedly violating the Civil Monetary Penalties Law. The disclosed conduct concerned professional claims that Northwell's professional corporate affiliate, North Shore, submitted to Medicare and Medicaid for evaluation and management services performed at certain hospitals and facilities. Northwell and North Shore disclosed that North Shore's Revenue Cycle Unit had undertaken a focused coding initiative that results in upcoding in the following subsets of claims: (1) claims for level 3, 4, and 5 emergency department evaluation and management services; (2) claims for level 4 and 5 internal medicine evaluation and management services; (3) claims for level 4 and 5 radiation oncology evaluation and management services; and (4) claims for level 4 and 5 urology evaluation and management services. OIG alleged that these subsets of claims were false or fraudulent because the claims furnished were not consistent with the level of evaluation and management service coded.

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