Corporate Compliance

Georgia hospital system pays $2.7 million to settle inappropriate billing charges

Compliance Monitor, February 16, 2011

St. Joseph’s/Candler Health System (SJCHS) agreed to pay $2.7million to settle allegations that two SJCHS locations received excessive Medicaid reimbursements, according to a Georgia Attorney General press release.

The settlement resolves claims that SJCHS inappropriately billed for patients who are enrolled in both Medicare and Medicaid. In those situations, Medicare acts as the primary coverage, with Medicaid functioning as the secondary insurance. SJCHS allegedly filed claims that did not reflect the full amount of Medicare prior payments, which resulted in SJCHS receiving excessive Medicaid reimbursements.

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