Grady Memorial Hospital officials have sent bills totaling $75 million to counties for services that were provided to their residents but went unpaid.

Some counties have taken the request seriously, but others suspect the move is a publicity stunt or part of a strategy to entice more dollars for Grady from the state government.

“We need help,” said Grady CEO Michael Young, noting the hospital expects a deficit of $40 million to $50 million for 2008. “In the end of the day, everybody needs to help a little bit.”

The hospital sent the bills this month to about 100 counties. According to Grady, Cobb County owes $10 million. Gwinnett County owes $12.6 million and Clayton County, with the biggest bill, owes $13 million.

The smallest bill arrived in Calhoun County —- for $38.13. Fulton and DeKalb weren’t docked since they already contribute an annual total of about $100 million to Grady.

Cobb County Commission Chairman Sam Olens said Cobb would not pay the bill. Cobb’s two large hospitals provide about the same amount of unpaid care for DeKalb and Fulton residents as Grady provides for Cobb residents, Olens said.

Moreover, he said, Cobb County government is not legally responsible for the medical bills of its residents who use Grady. Olens said numerous hospitals are losing millions of dollars by providing unpaid care.

“There’s nothing gained in a spat between Grady and Cobb,” Olens said. “This is a state issue.”

Other county officials and health advocates said Tuesday that they don’t expect Grady will be paid, especially with the current economic strain on counties.

Grady officials maintain that the state’s largest and busiest safety-net hospital serves many needy people from across the state. They also say hospitals in other counties don’t have the same level of trauma care as Grady and aren’t as accommodating to the poor’s needs.

Grady, facing another year of huge debt and losses, wants these counties to pay, at least for the costs in 2008.

“Are we expecting every penny?” Young said. “No. Would I take some dollars? Yes. The point is we need to sit down and talk about this.”

Olens said he has attended meetings with legislators and Grady officials where they discussed the prospect that Grady would request money from the counties before coming to the state for more money.

Young said he knew of no such conversations. He said he did want to send a message to the state on the large role played by Grady statewide, with the hope that the state would provide more funding.

Officials from Gwinnett, Douglas, Cherokee and Henry counties said they are reviewing the bills and have not determined what they would do.

“We’re still looking into it,” said Gwinnett spokeswoman Heather Sawyer.

“It would be difficult for us to pay that bill” because of budget constraints, said Douglas spokesman Wes Tallon, whose county was billed $2.4 million.

One state legislator from Cobb criticized Grady for the billing, and said it could backfire. “I truly think this is a publicity stunt, and I think it’s counter-productive,” said Rep. Earl Ehrhart (R-Powder Springs). “You go over the top, and you hurt your cause.”

He also said he didn’t expect the counties would pay the bills.