Skyline Urology to pay $1.85M over improper billing allegations — 5 details

Skyline Urology in Baltimore agreed to pay the government $1.85 million to resolve allegations it violated the False Claims Act.

Five details:

1. Skyline Urology allegedly billed Medicare for evaluation and management services that weren't allowable under Medicare between Jan. 1, 2013, and Dec. 31, 2016.

2. The practice is accused of using Modifier 25 to improperly unbundle routine E&M services, therefore receiving improper compensation from Medicare for certain urological services.

3. When E&M services are provided the same day as another procedure billed, providers can only use Modifier 25 to bill Medicare for those services if they're "significant, separately identifiable and above and beyond the usual preoperative and postoperative care associated with the medical procedure."

4. Skyline Urology's $1.85 million settlement resolves allegations in a lawsuit filed by Bay Area Healthcare Advisors Founder James M. Cesare. Mr. Cesare will receive about $323,750 from the settlement.

5. No liability was determined in the case. Skyline Urology agreed to undergo regular monitoring of its billing practices for three years.

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