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Virginia Hospital Settles False and Fraudulent Medicare Claims Case

On January 12, 2018, Carilion Medical Center, Inc. d/b/a Carilion Roanoke Memorial Hospital, Carilion Services, Inc., and Carilion Clinic (collectively, "Carilion"), Virginia, entered into a $403,960.75 settlement agreement with OIG. The settlement agreement resolves allegations that Carilion submitted claims for "new patient" evaluation and management outpatient clinic visits using Healthcare Common Procedure Coding System (HCPCS) codes 99201-99205 when the patients at issue were actually "established patients" and, thus, Carilion should have submitted those claims using the generally lower-paying HCPCS codes 99211-99215. OIG's Office of Audit Services and Office of Counsel to the Inspector General, represented by Senior Counsels Geoffrey Hymans and Andrea Treese Berlin, collaborated to achieve this settlement.

Action Details

  • Date:January 12, 2018
  • Enforcement Types:
    • CMP and Affirmative Exclusions