Northwell Health in New Hyde Park, N.Y., has agreed to pay $12.73 million in a civil monetary penalty settlement over its Medicare billing for vertebroplasty, a spine procedure, which allegedly didn’t comply with a local coverage decision (LCD). Northwell Health found the billing errors itself after adding vertebroplasty to its risk assessment, and disclosed them to the HHS Office of Inspector General.

According to OIG, Northwell settled allegations that its hospitals submitted claims to Medicare that didn’t meet the LCD for vertebroplasty and vertebral augmentation – percutaneous (L26439) because the supporting documentation didn’t demonstrate (1) the failure of nonsurgical medical treatment, which usually lasts six weeks, or (2) the presence of a pathological fracture, such as osteoporotic fracture, and not just a fracture attributable to trauma.

Although hospitals don’t relish the thought of paying millions of dollars to the government, overpayments are inevitable, and their discovery is proof of an effective compliance program, says Greg Radinsky, senior vice president and chief corporate compliance officer at Northwell Health.

“It shows the process is working,” he tells RMC. “We saw there were errors and self-disclosed them.” Only 10 of Northwell’s 22 hospitals, which are on Long Island and in New York City and Westchester County, submitted claims with insufficient documentation to support vertebroplasty.

Vertebroplasty landed on Northwell’s internal work plan after it identified an increase in the number of procedures performed. Northwell conducts about 200 internal audits annually, and 80 or so are coding audits, Radinsky says.