St. Agnes Healthcare in Baltimore has reached an agreement with federal authorities Wednesday to resolve allegations that it had submitted false claims to Medicare. St. Agnes allegedly billed for management and evaluation services at a higher reimbursement rate than permitted by federal health care programs.
As part of the agreement, St. Agnes will pay the United States $122,928 to resolve the lawsuit filed under the whistleblower provision of the False Claims Act. Dr. Jonathan Safren, a cardiologist who was employed by St. Agnes, filed the lawsuit on behalf of the United States. Safren will receive $20,000 of the settlement, as part of the resolution, according to court documents.
St. Agnes acquired a medical practice with 12 cardiologists who were members of the MidAtlantic Cardiovascular Associates, in June 2011. E&M services provided to new patients qualify for a higher reimbursement through Medicare than established patients.
From June 3, 2011 through June 3, 2014, St. Agnes submitted claims for E&M services provided by those 12 cardiologists to Medicare utilizing the wrong CPT codes. The patient codes were for new patients instead of existing patients. As a result, St. Agnes received larger reimbursements under Medicare.