University Health Associates Agreed to Pay $56,925 or Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Upcoded Evaluation and Management Services

After it self-disclosed conduct to OIG, West Virginia University Medical Corporation d/b/a University Health Associates (UHA), Morgantown, West Virginia, entered into a $56,925 settlement agreement with OIG. The settlement agreement resolves allegations that UHA submitted false claims to Medicaid and TRICARE, as primary payers, for split or shared Evaluation and Management services purportedly performed by a formerly employed pediatric neurologist. The claims were false because the underlying medical records were falsified to inflate the total time spent in care of the patient resulting in a higher level of reimbursement than should have been paid.