Skyline Urology has agreed to pay $1,850,000 to the United States to resolve claims under the False Claims Act alleging that the company submitted false claims to Medicare by billing for evaluation and management services that were not eligible for reimbursement. The company provides urology care in Southern California. It is headquartered in Torrance, California. The Medicare claims were paid in Maryland.
Skyline presents claims to and is paid by health insurance plans. The amount payable includes the evaluation costs. Health care providers are not permitted to bill for evaluation and management services on the same day the procedure is performed. There are some exceptions to the rule. Under certain circumstances, a provider may bill for the E&M services and the procedure. It will do so by submitting the bill with a special code, which permits both claims to be paid.
If the company uses the code incorrectly, overbilling will occur. According to the settlement agreement, the United States alleges that Skyline improperly used the code to falsely claim that E&M services were unassociated with other procedures performed on the same day and therefore were eligible for separate reimbursement from January 1, 2013 to December 31, 2016. Skyline denied the allegations.
The company has entered into an Integrity Agreement with the United States Department of Health and Human Services, Office of Inspector General that will require regular monitoring of the company’s billing practices for three years. Further details can be found here.