A medical group, its subsidiary and its former physician president will pay more than $60 million for allegedly submitting false diagnosis codes to inflate Medicare Advantage payments, according to a March 26 news release from the Justice Department.
What happened?
- Los Angeles-based Seoul Medical Group and its subsidiary will pay $58.7M, and former president Min Young Cha, MD, who was president and majority owner until 2023, will pay $1.76M for his role in the scheme.
- From 2015 to 2021, Seoul Medical — which has worked with around 150 primary care providers and 1,000 specialists — falsely claimed patients had spinal enthesopathy and sacroiliitis, conditions that increase Medicare risk scores and payments.
- These actions led to inflated payments from Medicare to the Medicare Advantage plans, which then passed funds to Seoul Medical.
Who else is involved?
- Renaissance Imaging Medical Associates, a Los Angeles-based radiology group, will also pay $2.35M for allegedly helping fabricate radiology reports to support the false diagnoses.
“We are pleased to have resolved this matter and demonstrated that SMG reversed the conduct described in the settlement. The settlement will not have any financial, operational or other costs or impact to SMG or AMM,” a spokesperson for the group said in a statement. “We are committed to continually enhancing our practices and maintaining the highest standards of compliance. We remain focused on our mission of serving our communities and improving access, affordability and quality of healthcare for our patients.”