Geisinger to Pay $18M Settlement Over Medicare Billing Violations

The US Attorney’s Office for the Middle District of Pennsylvania announced that Geisinger Community Health Service (GCHS) reached an agreement to pay more than $18.5 million for allegedly violating Medicare billing rules for hospice and home health services. 

GCHS voluntarily disclosed the violations between January 2012 and December 2017 to the United States Attorney’s Office.

The settlement resolves allegations concerning GCHS submitting claims to Medicare for hospice and home health services that violated Medicare rules and regulations regarding physician certifications of terminal illness, patient elections of hospice care, and physician face-to-face encounters with home health patients.  

“As part of a routine self-audit, Geisinger uncovered billing deficiencies related to home health and hospice services from 2012 to 2017. We promptly took corrective action, notified the federal government and cooperated fully with the government leading up to this settlement. Since uncovering these deficiencies, we have conducted follow-up audits that have shown 100 percent compliance, and we do not anticipate any further billing deficiencies related to these services,” said spokesperson from the health system, regarding the claims.

According to the Department of Justice (DOJ), once Geisinger uncovered the fraudulent claims, they reported it to the United States Attorney’s Office,” said spokesperson from the health system, regarding the claims. 

“The $18 million payment in this matter reflects the priority healthcare providers should place on making sure they closely follow all Medicare rules and regulations,” said Acting US Attorney Brandler in a press release, “Healthcare fraud remains a focus of the Department of Justice and the Affirmative Civil Enforcement Unit of the United States Attorney’s Office. I commend GCHS for taking this seriously, voluntarily disclosing these issues to our office, and working to address the problems that led to these violations".

Geisinger Community Health Services is one of many healthcare organizations that settled due to fraud allegations. According to the 2020 annual report from the Health Care Fraud and Control Program (HCFAC), an estimated $3.1 billion was paid over to the federal government and private person due to healthcare fraud investigations. 

The report states, the DOJ had 1,148 criminal fraud investigations in 2020. In addition, Medicare and Medicaid fraud resulted in 781 civil actions and 578 illegal actions. 

“Health care fraud targets the vulnerable in our communities, our health care system, and our basic expectation of competent, available care,” said Calvin Shivers, Assistant Director of the FBI’s Criminal Investigative Division, in a press release referencing healthcare fraud.

 Medical billing audits can help healthcare organizations catch possible slip-ups and get ahead of audits conducted by the federal government.