Medical Center to pay $20 million to settle Medicare billing dispute

The Medical Center of Central Georgia on Pine Street, pictured in 2008.
The Medical Center of Central Georgia on Pine Street, pictured in 2008. bcabell@macon.com

The Medical Center of Central Georgia Inc. will pay the federal government $20 million to settle allegations that it incorrectly billed Medicare for some patient admissions.

The government alleged that the hospital violated the False Claims Act by improperly submitting claims to Medicare for more expensive short-stay inpatient services that should have been billed as less costly outpatient cases between January 2004 and August 2008, the U.S. Department of Justice announced Monday.

“Charging the government for higher-cost inpatient services when the patient care received was outpatient or observation services causes Medicare to pay more than it should,” Principal Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department’s civil division said in a release.

The Macon hospital agreed to settle “to avoid costly and protracted litigation” and “cooperated fully” with the government, according to a statement from Navicent Health, the parent company of what is now called Medical Center, Navicent Health. The settlement did not determine liability.

“Integrity is a core value at The Medical Center of Central Georgia,” Ninfa M. Saunders, Navicent Health’s president and CEO, said in the release. “We take compliance very seriously and continue to strengthen our already strong compliance policies and procedures.”

The hospital’s current compliance program includes the use of physician advisers and 100 percent pre-bill review of Medicare inpatient orders, the release said.

As part of the settlement, the hospital entered into a corporate integrity agreement with the U.S. Department of Health and Human Services-Office of the Inspector General that will require the hospital to provide employees with additional compliance training for the next five years. The hospital also will retain an independent party to review its claims for services to federal health care program beneficiaries.

The Medical Center release said that for years hospitals have had difficulty interpreting whether a short hospital stay should be billed to Medicare as an inpatient or outpatient claim, and other hospitals have settled similar claims with the government.

The decision to admit a patient involves “complex medical judgment” and is decided by the attending physician, the release said.

Since January 2009, the False Claims Act has helped the federal government recover more than $24 billion, with more than $15.3 billion of that from cases involving fraud against federal health care programs.