Billing errors prompt UPMC agreement to pay $956,590 to end federal review

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UPMC has agreed to pay nearly $1 million to settle a False Claims Act review by U.S. Attorney David Hickton's office following the hospital network's disclosure of billing errors associated with its home health arm.

The $956,590 settlement ends a federal review of UPMC and UPMC VNA Home Health, known as UPMC Home Health, without the filing of any litigation, Mr. Hickton's office announced.

According to a press release from Mr. Hickton's office, UPMC voluntarily disclosed information "concerning referrals for home health services made from UPMC hospitals to UPMC Home Health. Based on information provided by UPMC, the United States alleged that it had civil claims against UPMC and UPMC Home Health resulting from Medicare billings for home health services that were not supported by a documented face-to-face encounter with a physician or authorized non-physician practitioner, as required by Medicare rules and regulations."

The press release indicated that the Office of Inspector General of the Department of Health and Human Services investigated the matter.

UPMC issued a statement indicating that it admitted no liability, and "chose to settle the matter to avoid a lengthy dispute" and stay focused on medicine.

The hospital system's statement said that the settlement stemmed from "newly required documentation" and "errors in a relatively small percentage of cases" which were disclosed to the government.

"Our review determined that we had ultimately complied with all Medicare rules associated with providing the services because other documentation existed to support the medical services provided and that all services were both provided, and were medically appropriate," according to UPMC's statement.

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Rich Lord: rlord@post-gazette.com, 412-263-1542 and on Twitter: @richelord.


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