Penn Medicine agrees to pay $275,000 for allegedly submitting false reimbursement claims

The Trustees of the University of Pennsylvania Health System have agreed to pay $275,000 to settle allegations under the False Claims Act, which imposes liability on people or companies who defraud government programs.

U.S. Attorney William McSwain announced on June 26 that Lancaster General Hospital’s division of Maternal Fetal Medicine, a part of the Penn Medicine network, submitted false claims to Medicaid for obstetric ultrasounds between May 2017 and December 2018, according to the United States Attorney's Eastern District of Pennsylvania Office.

Medicaid is one of the largest payers for health care in the United States and provides health coverage to low-income people.

Physicians failed to complete reports on time analyzing ultrasound studies ordered for obstetric patients. Without a timely report, Medicaid cannot reimburse a physician for their professional interpretation of the ultrasound, according to the U.S. Attorney's Office. 

The government alleges LGH-MFM physicians took more than thirty days to complete professional reports of ultrasound studies and, in 10% of cases, the report was not finalized until more than 90 days after the ultrasound was performed.

LGH-MFM is alleged to have violated the False Claims Act by submitting claims for reimbursement to Medicaid for ultrasound reports when employees “knew or should have known the claims were not reimbursable due to the extreme delays in completing the physician’s reports.”

“This alleged conduct not only demonstrated an abuse of the Medicaid program, but had troubling potential implications for patient care," McSwain said. "Medicaid beneficiaries, especially expectant mothers carrying high risk pregnancies, deserve better."

The U.S. Attorney’s Office opened the case based on a citizen tip that was investigated by the U.S. Department of Health and Human Services Office of the Inspector General. 

This announcement comes a month after allegations that a Penn Med employee improperly accessed patient records.