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University of California Medical Center Settles False and Fraudulent Medicare Claims Case

On September 28, 2016, University of California San Francisco Health d/b/a UCSF Medical Center (UCSF), entered into a $1,443,016 settlement agreement with OIG. The settlement agreement resolves allegations that UCSF submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99203-99205 when the patients at issue were actually "established patients" and, thus, UCSF should have submitted those claims using the lower-paying HCPCS codes 99213-99215. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Andrea Treese Berlin and Geoffrey Hymans, collaborated to achieve this settlement.

Action Details

  • Date:September 28, 2016
  • Enforcement Types:
    • CMP and Affirmative Exclusions