The Medical Center of Central Georgia, Inc. has agreed to a $20 million settlement with the federal government to resolve allegations related to how certain patient admissions were billed to Medicare from January 2004 to August 2008. 

The government contends the hospital improperly submitted claims to Medicare for short-stay inpatient admissions that should have been billed as outpatient cases. MCCG agreed to settle in order to avoid costly and protracted litigation and cooperated fully with the government to resolve this matter.

The high-quality care that patients and families received was not affected by this issue. At all times, patients received medically necessary services, and the government did not claim otherwise.

In addition, MCCG entered into a Corporate Integrity Agreement with the government’s Office of Inspector General that will require the hospital to provide its employees with additional compliance training and other measures.  MCCG will retain an outside party to conduct focused reviews and report findings to MCCG and to the government. 

 “Integrity is a core value at The Medical Center of Central Georgia,” said Ninfa M. Saunders, President and CEO. “We take compliance very seriously and continue to strengthen our already strong compliance policies and procedures."

MCCG has a very well-established compliance program including:

• Use of physician advisors and 100 percent pre-bill review of Medicare inpatient orders.

• Utilization review process for Medicare admissions.

• Substantial resource investment in compliance program.

For many years hospitals across the country have had difficulty interpreting whether a short hospital stay should be billed to Medicare as an inpatient claim or as an outpatient claim. Many other hospitals have settled similar cases with the government. 

The decision to admit a patient involves complex medical judgment. To determine whether or not a patient is admitted as an inpatient is the responsibility of the attending physician based on the physician's clinical judgment.