The Macon-based Medical Center of Central Georgia, the second largest hospital in the state, will pay $20 million to settle allegations that it violated the False Claims Act by billing Medicare for more expensive inpatient services instead of less costly outpatient or observation services, the U.S. attorney’s office said.
Federal authorities allege that from 2004 to 2008 the hospital “knowingly” charged Medicare for “medically unnecessary inpatient admissions when the care provided should have been billed as less costly outpatient or observation services.”
“Unnecessarily admitting patients who could have been treated in an out-patient or observation setting is not only a waste of taxpayer dollars, but a fundamental breach of trust,” said Derrick L. Jackson, special agent in charge of the U.S. Department of Health and Human Services, office of inspector general in Atlanta.
“Medicare beneficiaries must feel secure and know that the care selected for them is in their best interest, and not merely what will generate the most revenue for the facility.”
Since January 2009, the U.S. Justice Department has recovered more than $24 billion through False Claims Act cases, with more than $15.3 billion of that from cases involving fraud against federal health care programs.
The hospital also will be required for the next five years to have an independent organization review the accuracy of the company’s claims for services furnished to federal health care program beneficiaries.