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Georgia Hospital to Pay $20 Million for Allegedly Overbilling the Government for In-Patient vs. Out-Patient Hospital Care

On Monday, April 27, 2015, the Department of Justice (DOJ) announced that The Medical Center of Central Georgia (MCCG), the second largest hospital in Macon, Georgia, agreed to a $20 million settlement to resolve allegations that it violated the False Claims Act (FCA) by overbilling Medicare for unnecessary inpatient care.  According to the lawsuit filed by the government, MCCG allegedly charged Medicare for services rendered to patients admitted into the hospital, when less expensive outpatient care would have sufficed.  Knowingly billing the government for unnecessary procedures, services, or hospital stays violates the FCA and is considered Healthcare fraud.  Additionally, when profits are considered more important than the best interests of patients, trust in the health care system is eroded, and taxpayer dollars are wasted.

Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources, and also offers benefits not normally covered by Medicare, like nursing home care and personal care services.  When a company or individual knowingly bills the Medicaid or Medicare system for bogus or unnecessary services, it is a violation of the FCA.   According to the government, MCCG allegedly continued, for a period of four years between 2004 and 2008, to overbill Medicare for services rendered to patients that qualified for observation or outpatient care, but not for the overnight hospital stays for which Medicare was billed.  The government alleged that MCCG’s motive was to increase its revenue, and an investigation into it practices revealed MCCG’s alleged violations.

As part of the settlement agreement, MCCG entered into a corporate integrity agreement (a “CIA”) with the Office of Inspector General of the U.S. Department of Health and Human Services.  That CIA requires the company to adhere to the rules and regulations outlined in the agreement for a period of five years.

© 2020 by Tycko & Zavareei LLPNational Law Review, Volume V, Number 119


About this Author

Jonathan K. Tycko, Civil Litigation Attorney, Tycko Zavareei Law firm

Mr. Tycko has represented clients in numerous qui tam whistleblowing cases, in areas including Medicare fraud, government contracts fraud, and tax fraud. In addition, with the 2010 passage of the Dodd-Frank Act, Mr. Tycko’s practice has expanded into representation of whistleblowers in the areas of securities and commodities, and violations of the Foreign Corrupt Practices Act.

Mr. Tycko focuses his practice on civil litigation, with special concentrations in whistleblower cases, consumer class actions, unfair competition litigation, employment litigation and housing litigation. He...