Skyline Urology, Medicare False Claims, Maryland 2023

Grimy Times has uncovered a shocking case of Medicare fraud in Maryland.

Skyline Urology, a urology care provider based in Torrance, California, with operations in the South Bay area in Southern California, has agreed to pay the United States $1,850,000 to resolve claims under the False Claims Act alleging that Skyline submitted false claims to Medicare by billing for evaluation and management (E&M) services that were not eligible for reimbursement.

The alleged false claims act case was filed in U.S. District Court in Maryland, since Medicare claims were paid in Maryland.

According to the settlement agreement, the United States contends that from January 1, 2013, through December 31, 2016, Skyline improperly used the code to falsely claim that E&M services were unrelated to other procedures performed on the same day on the same patient, and thus, eligible for separate reimbursement. In fact, the E&M services were performed as part of, and in connection with, other procedures performed on the same day on a single patient, and Skyline received more reimbursement than it was entitled to under Medicare.

Skyline denies the allegations.

The civil settlement resolves a lawsuit filed under the whistleblower provision of the False Claims Act by James M. Cesare (United States and State of California ex rel James M. Cesare v. Skyline Urology., Civil Case No. JKB-16-4059 (D. Md.)). The False Claims Act permits private parties to file suit on behalf of the United States for false claims and obtain a portion of the government’s recovery. As part of today’s resolution, Mr. Cesare will receive $323,750.

The U.S. Attorney’s Office for the District of Maryland is committed to thoroughly investigating claims of fraud and holding health care providers accountable when they break the rules, said U.S. Attorney Robert K. Hur. This settlement is an example of how whistleblowers and government can work together to recoup funds and deter overbilling practices.

Skyline Urology has also entered into an Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General that will require regular monitoring of its billing practices for three years.

Providers are expected to closely follow Medicare rules and bill properly — nothing more, nothing less, said Maureen R. Dixon, Special Agent in Charge of the Office of Inspector General of the U.S. Department of Health and Human Services. Taxpayer money wasted is money stolen from this vital federal health program.