Penn Medicine agrees to pay $275K for improper Medicaid bills

The University of Pennsylvania Health System has agreed to pay $275,000 to settle allegations that its member Lancaster General Hospital improperly filed for Medicaid reimbursement of obstetric ultrasound studies, the U.S. Attorney’s Office said Wednesday.

For Medicaid to reimburse a physician for an interpretation of an ultrasound, the doctor must complete a report for the patient’s medical record. The government alleged that for seven months in 2017, many obstetric ultrasound reports completed by Lancaster General maternal-fetal medicine doctors were so delayed that they were worthless, and therefore should not have been reimbursed by Medicaid. In some cases, the reports were not completed until after the patient delivered.

“Maternal-fetal medicine physicians manage the most high risk and complex pregnancies,” U.S. Attorney William McSwain said in a news release. “This alleged conduct not only demonstrated an abuse of the Medicaid program, but had troubling potential implications for patient care. Medicaid beneficiaries, especially expectant mothers carrying high risk pregnancies, deserve better.”

The investigation, prompted by a complaint from citizens, was led by the U.S. Department of Health and Human Services’ Office of the Inspector General.