Medical Group Settles CMP Case for $807,255 Over Professional Fees

Florida Hospital Medical Group Inc., d/b/a AdventHealth Medical Group, has agreed to pay $807,255 in a civil monetary penalty settlement about billing professional fees for procedures that allegedly weren’t performed.

According to the settlement, which was obtained through the Freedom of Information Act, the HHS Office of Inspector General (OIG) alleged that AdventHealth Medical Group submitted claims to Medicare, Medicaid, TRICARE and Railroad Medicare for items or services that were fraudulent from May 1, 2015, through April 31, 2021.

OIG contends AdventHealth Medical Group billed professional fees for a physician’s “pulmonary, laparoscopic, hiatal hernia repair, rib resection, and thoracoscopy surgeries that included codes for procedures that were not performed.” The settlement stemmed from a self-disclosure. AdventHealth Medical Group was accepted into OIG’s Self-Disclosure Protocol on Aug. 3, 2021. It didn’t admit liability in the settlement.

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