Recent improper billing activity tops $120 million in Georgia
More than $120 million in improper billing activity has taken place in Georgia over the past week. On Monday, a hospital settled allegations from federal prosecutors that it violated the False Claims Act by cutting a check for $20 million, according to a Department of Justice statement. Meanwhile, Georgia Health News reported that Centers for Medicare & Medicaid Services (CMS) officials want the state's Medicaid program to return $100 million in overpayments to nursing homes.
The Medical Center of Central Georgia (MCCG), located in Macon, was charged with billing Medicare for unnecessary inpatient admissions that should have been billed as outpatient or observation services. Prosecutors allege that the overpayments took place from 2004 through 2008. In addition to paying $20 million, the facility entered a corporate integrity agreement with the Office of Inspector General (OIG) that requires it to conduct an independent review of Medicare billing claims.
"Overcharging the government for medical services wastes our country's limited healthcare resources," Acting U.S. Attorney John Horn of the Northern District of Georgia said in a statement. "When a provider inflates its billings, we will aggressively seek to recover the overcharges under the False Claims Act."
Overbilling for inpatient services has been problematic throughout the country. In February, UNC Hospitals said it planned to fight an OIG report that claimed the hospital overcharged the government $2.5 million for inpatient and outpatient services, FierceHealthPayer: AntiFraud previously reported.
In 2012, a Florida health system paid $10.1 million to settle claims that it overbilled for cardiac inpatient procedures. Months later, Adventist Health System, also located in Florida, was accused of overbilling Medicare, Medicaid and Tricare for more than 10 years.
Meanwhile, CMS has asked the state of Georgia to pay back more than $100 million in overpayments made to nursing homes between 2010 and 2011, according to GHN. The agency says the state mischaracterized privately owned nursing facilities as state-owned in order to get higher reimbursement rates through Upper Payment Limits (UPLs). In December, CMS officials told the state to "cease and desist" the Medicaid billing practice.
Terri Coughlin, a senior fellow with the Urban Institute, told the news outlet that federal officials are closely watching UPLs because it's an area with a history of abuse.
For more:
- here's the DOJ statement
- read the GHN article
Related Articles:
UNC Hospitals intends to fight OIG audit that reveals $2.5M in overbilling
Health systempays $10.1M to settle overbilling charges
Whistleblower accuses Adventist Health of overbilling millions
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