Report on Medicare Compliance 29, no. 20 (June 1, 2020)

◆ The HHS Office of Inspector General (OIG) has unveiled its “OIG Strategic Plan: Oversight of COVID-19 Response and Recovery.”^[1] Its goals are protecting people, funds and infrastructure, and promoting effectiveness of HHS programs. For example, OIG will “identify and investigate suspected fraud, in coordination with Federal, State, local, and Tribal law enforcement partners, and exercise OIG’s administrative enforcement authorities when appropriate; conduct audits and evaluations to identify program integrity vulnerabilities and recommend safeguards; and alert HHS, enforcement partners, and industry stakeholders to potential fraud risks or schemes to steal funds.”

◆ Southern Illinois Healthcare; Southern Illinois Medical Services NFP, doing business as SIH Medical Group; and Southern Illinois Hospital Services, doing business as Memorial Hospital of Carbondale, Herrin Hospital, and St. Joseph Memorial Hospital, agreed to pay $208,306 to settle a civil monetary penalty case with the HHS Office of Inspector General. According to the settlement, which was obtained through the Freedom of Information Act, the respondents provided remuneration to one physician “in the form of patient referrals from SIH Medical Group” from Oct. 1, 2014, through Sept. 30, 2015, and to another physician from Oct. 1, 2014, through April 30, 2016. The respondents self-disclosed to OIG and were accepted into the Self-Disclosure Protocol. Their attorney declined RMC’s request for comment.

◆ Premier Medical Associates (PMA), a medical practice in The Villages in Florida, agreed to pay $750,000 to settle false claims allegations,^[2] the U.S. Attorney’s Office for the Middle District of Florida said May 20. The government alleged that PMA billed for higher levels of service than were performed and used modifier 25 to charge for separate evaluation and management services when no E/M service was provided.

1 OIG, “OIG Strategic Plan: Oversight of COVID-19 Response and Recovery,” HHS, May 2020, https://bit.ly/3emxfYV.
2 Department of Justice, U.S. Attorney’s Office for the Middle District of Florida, “Premier Medical Associates Agree To Pay $750,000 To Resolve Claims Of False Billing,” news release, May 20, 2020, https://bit.ly/3c9DA8A.

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