NEWARK, N.J. – A New Jersey pathology practice will pay $2.4 million to resolve allegations that it violated the False Claims Act by making false representations in connection with submissions to the Centers for Medicare & Medicaid Services (CMS), Acting U.S. Attorney Rachael A. Honig announced today.
According to the government’s contentions in the settlement agreement:
Princeton Pathology Services P.A. (Princeton Pathology) submitted claims to Medicare under Current Procedural Terminology (CPT) code 85390-26 from Jan. 1, 2015, through Dec. 31, 2020. This CPT code requires written analysis by a pathologist, but Princeton Pathology submitted claims using this code without written substantiation in medical records. As a result, Princeton Pathology billed Medicare for analysis of tests that did not require analysis, causing Medicare to significantly overpay.
Contemporaneous with the civil settlement, Princeton Pathology also entered into a three-year Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), which requires, among other things, training, auditing, and monitoring designed to address the conduct at issue in the case as well as evolving compliance risks on an ongoing basis.
“Federal health care programs rely on practitioners to accurately bill for services they perform,” Acting U.S. Attorney Honig said. “The U.S. Attorney’s Office for the District of New Jersey will hold accountable physician practices...
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