The second-largest hospital in the state of Georgia has agreed to pay $20 million to resolve claims that it submitted false claims to Medicare, which caused the government to pay significantly more than it should have for the hospital’s services. Based in Macon, the Medical Center of Central Georgia (MCCG) allegedly billed Medicare for expensive inpatient care when it was actually providing less costly outpatient care.
Hospitals generally receive significantly higher Medicare reimbursement for inpatient services as opposed to outpatient services. The government contends that between 2004 and 2008, MCCG knowingly billed Medicare for medically unnecessary inpatient admissions when the care that it actually provided should have been billed as outpatient or observation services.
In addition to the $20 million, the settlement also requires the company to maintain an independent review organization for a period of five years to ensure the accuracy of its claims for services provided to Medicare beneficiaries.
Today’s settlement shows what can happen when health care companies provide services based on financial rewards rather than the health and wellbeing of their patients. Medicare beneficiaries should feel secure in knowing that the care they are receiving is beneficial and medically necessary. When providers choose care based solely on what generates the most revenue, it jeopardizes the health of Medicare beneficiaries who are some of our most vulnerable citizens and makes taxpayers pay for it.
This case highlights the need for whistleblowers to come forward and expose corporate wrongdoing. If you have inside information about health care fraud, you should speak to an experienced whistleblower attorney as soon as possible to discuss your claim. Those who come forward and blow the whistle on health care fraud are eligible to receive sizable financial rewards if a claim is successful. They also play an integral role in saving taxpayer dollars and preserving the integrity of government programs like Medicare and Medicaid.