Hospital in Georgia settles doctor's Medicaid qui tam for nearly $14 million

by Ben Vernia | December 22nd, 2010

On December 22, the Department of Justice announced that a Georgia hospital has agreed to pay $13.9 million to settle allegations that it falsely certified that itwas a public hospital, resulting in false claims to the state’s Medicaid program. According to DOJ’s press release:

John D. Archbold Memorial Hospital Inc. has paid the United States a total of $13.9 million to settle allegations that the hospital submitted false claims to the state of Georgia’s Medicaid program, the Justice Department announced today.

The settlement resolves allegations that between November 2002 and July 2008, the Thomasville, Ga.-hospital made false representations to the Georgia Department of Community Health, the state agency that administers the Medicaid program in Georgia, that it was a public hospital for Medicaid purposes in order to increase the amount of Medicaid funds provided to the hospital. Under Medicaid rules, only public hospitals may participate in the Medicaid Upper Payment Limit (UPL) program. In addition, public hospitals receive additional Disproportionate Share Hospital (DSH) program funds that are not available to private hospitals. Contrary to its certification to the Georgia Department of Community Health, Archbold Memorial was in fact a private hospital, and as a result received millions of dollars in UPL and DSH funds to which it was not entitled.

The case was originally brought by a physician as a whistleblower. The doctor will receive nearly $700,000 (because the Department did not itemize the federal portion of the federal/state settlement, the percent share the relator received could not be determined).

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