Attorney General Sam Olens announced on April 23, 2015, that the state of Georgia has reached a civil settlement agreement with Grady Health System (Grady). Grady has agreed to pay $2,950,000 to settle claims that it inaccurately coded claims for neo-natal intensive care unit (NICU) patients, resulting in alleged damages to the Georgia Medicaid program.
Providers generally are permitted to bill only for those codes that are justified by the medical services provided. Here, the state of Georgia alleged that Grady inflated billings for certain services provided to NICU patients, resulting in either unjustified or inflated outlier payments from Georgia Medicaid. The claims settled in the civil settlement are allegations only, and there has been no determination of liability.
“This settlement demonstrates our office’s continued commitment to protecting crucial Medicaid dollars from fraud and abuse,” said Attorney General Sam Olens. “The health of NICU patients is fragile, and we must ensure that every Medicaid dollar is properly spent on their care.”
The civil settlement was reached by Senior Assistant Attorney General Nancy Allstrom. The case was initially developed by Myers & Stauffer, the Recovery Audit Contractor for the Georgia Department of Community Health, and was investigated by Investigator Shakethia Morgan, Nurse Investigator Beth Ann Teague, Analyst Tish Murray, and Assistant Attorney General Elizabeth White, all of the Georgia Medicaid Fraud Control Unit, a division of the Office of the Attorney General.