ATLANTA (Legal Newsline) - Georgia Attorney
General Sam Olens announced on Tuesday that his office has reached a
$2.7 million civil settlement with a health systems company that
allegedly defrauded Medicaid.
St. Joseph's/Candler Health System
allegedly reported inaccurate Medicaid billing at two Savannah,
Ga.-area hospitals for both inpatient and outpatient services.
The
Georgia Medicaid Fraud Control Unit and the Department of Community
Health utilized the auditing firm Myers & Stauffer to look into
cross-over claims that were allegedly filed by the company.
Cross-over
claims are those that are made on behalf of patients who are enrolled
in Medicaid and Medicare. For those patients, Medicare provides primary
coverage while Medicaid acts as secondary insurance.
A lawsuit
against SJCHS alleged it had filed claims that did not reflect the full
amount of Medicare prior payments, resulting in excessive Medicaid
reimbursements.
"All instances of over billing as well as
fraudulent billing in the state Medicaid system will be vigorously
investigated by my office," Olens said. "Every dollar is critical as
demand for Medicaid services is rising and public resources are scarcer
than ever. Aggressive enforcement is the best tool we have to make
certain that Georgia taxpayers are not overpaying for Medicaid
services."
Under terms of the agreement, SJCHS will pay
$2,717,370 to the Georgia Department of Community Health to cover all
alleged billing errors. The company will also pay an additional $2,500
for costs associated with the litigation.
SJCHS denied any
wrongdoing and cooperated with the state, implementing corrective
actions to ensure that similar overbilling doesn't happen.
A similar settlement was reached in August with five WellStar hospitals for $2,738,000.