Georgia Cancer Specialists has reached a settlement with the U.S. Attorney’s Office for the Northern District of Georgia in which the medical practice agreed to pay $4.1 million to settle claims that it violated the False Claims Act in Medicare billing.
The claims settled by the settlement agreement are allegations only; there has been no determination of liability.
Georgia Cancer Specialists is one of the largest private oncology practices in the country with 27 offices located throughout the Atlanta metro area, including Marietta.
The civil settlement resolves the United States’ investigation into Georgia Cancer Specialists’ practices relating to billing for evaluation and management (E&M) services on the same day as a related procedure. Generally, providers are not permitted to bill both E&M services and a related procedure on the same day under the Medicare program’s regulations. In specific circumstances, providers can avoid this prohibition by submitting their claims marked with modifier -25, which tells Medicare to pay both the procedure and the E&M service. Here, the U.S. Attorney’s Office alleged that Georgia Cancer Specialists applied modifier -25 to claims that did not qualify for its use, leading to overpayments by Medicare.
The U.S. Department of Health and Human Services, Office of Inspector General has targeted the use of modifier -25 in its yearly work plans because of what it describes as widespread abuse of the use of modifier -25.