Self-disclosure: Who Does That?

Although most providers aim to stay under the radar of the Office of Inspector General (OIG) and private payers for fraudulent billing practices, others hide intentional wrong-doing and are fearful of being discovered. While still other providers choose to self-disclose once errors and fraudulent conduct is revealed.

If your healthcare organization finds illegal billing activity, consider self-disclosure to avoid costly and long-drawn out litigation. The OIG says, “Self-disclosure gives providers the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.”

The Self-disclosers

According to the OIG’s “Provider Self-Disclosure Settlements,” recent self-disclosures to the OIG in the month of February included:

Feb. 8 – Highland Rivers Community Service Board, in Georgia, agreed to pay $133,067.26 for alleged violation of submitting claims for psychiatric telehealth services provided to Medicare patients at Highland Rivers locations that were not eligible for Medicare telehealth reimbursement.

Feb. 9 – CHRISTUS Health and CHRISTUS Santa Rosa Health Care Corporation, agreed to pay $148,095 for alleged physician self-referrals and kickbacks. CHRISTUS allegedly paid remuneration “above fair market value to a medical distributorship owned by a physician in exchange for the physician’s referrals of Federal healthcare beneficiaries to two hospitals owned and operated by CHRSITUS hospitals.”

Feb. 9 – Fennis Bledsoe and Atlanta Dental Clinic, Inc., in Indiana, agreed to pay $125,446 for allegedly submitting “claims to Indiana Medicaid for dental services provided by non-credentialed dentists under the names of dentists who were credentialed with Indiana Medicaid.”

Feb. 13 – Northwell Health Inc., in New York, agreed to pay $12,736,087 for allegedly submitting claims to Medicare that did not meet the requirements of Medicare Local Coverage Determination, “Veterbroplasty and Vertebral Augmentation – Percutaneous, L26439.” Documentation for those claims did not support:

1. That non-surgical medical treatment typically lasting at least six weeks had failed; or
2. The existence of pathological fracture (including osteoporotic fracture), and not simply a fracture attributable to traumatic causes.

Feb. 20 – Scotland Memorial Hospital, Inc., North Carolina, agreed to pay $252,455.56 for violation of the provider-based billing requirements for sleep diagnostic and treatment services provided at Scotland Sleep Center.

• About
• Latest Posts

Follow me

Michelle Dick

Executive Editor at AAPC

Michelle A. Dick has been executive editor for AAPC for over 10 years. Prior to her work at AAPC, she was editor-in-chief at Eli Research and Element K Journals, and disk ad coordinator, web designer/developer, and graphic artist at White Directory Publishers, Inc. She has a Bachelor of Science in Graphic Design from the State University of New York - Buffalo State and is a member of the Flower City Professional Coders in Rochester, N.Y.

Follow me

Latest posts by Michelle Dick (see all)

• Busted! Florida “Pain Management” Clinic Runs an Opioid Pill Mill - November 14, 2018
• 5 Trends Shaping the Health Insurance Market - November 6, 2018
• Government Responds to Hurricane Michael’s Devastation - October 18, 2018