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Sonora Regional Medical Center Agreed to Pay $597,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Upcoded Services

After it self-disclosed conduct to the OIG, Sonora Regional Medical Center (SRMC) California, agreed to pay $597,193 for allegedly violating the Civil Monetary Penalties Law. SRMC contracted with a physician to provide professional services at SRMC's medical oncology outpatient center. The OIG alleged that SRMC submitted claims containing CPT codes 99204, 99205, 99214, and 99215, that it submitted for services provided by the physician that were upcoded and that the physician engaged in a pattern or practice of coding at a higher level that he knew or should have known would result in a greater payment than the code applicable to the services he was actually providing.

Action Details

  • Date:July 8, 2013
  • Enforcement Types:
    • Fraud Self-Disclosures