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Medicaid

Grady settles with state in overbilling case

Grady Health System has agreed to pay $2.95 million to settle charges that it improperly billed Medicaid for treatment to neonatal intensive care (NICU) patients, the Georgia attorney general announced Thursday.

Sam Olens

Sam Olens

The state of Georgia alleged that Grady inflated billings for certain services provided to these NICU patients, resulting in either unjustified or inflated payments from Medicaid.

“This settlement demonstrates our office’s continued commitment to protecting crucial Medicaid dollars from fraud and abuse,” said Attorney General Sam Olens in a statement. “The health of NICU patients is fragile, and we must ensure that every Medicaid dollar is properly spent on their care.”

A spokeswoman for Olens said the Grady billing problem occurred from March 2008 to November 2012. Lauren Kane, the spokeswoman, told GHN in an email that “no single individual’’ at Grady was responsible for the overbilling. full story

Georgia fires back on nursing home payments

The commissioner of Georgia’s Medicaid agency has written a sharply worded defense of nursing home payments now deemed improper by the federal government.

Clyde Reese

Clyde Reese

A federal ruling saying Georgia should return more than $100 million in nursing home payments “is factually and legally incorrect,’’ Clyde Reese, commissioner of the Department of Community Health, wrote in a February letter to a Centers for Medicare and Medicaid Services (CMS) official in Atlanta.

“Refunding payments previously approved by CMS would be inequitable and would result in unjust enrichment to the federal government,”  Reese said. It would probably also lead to the closure of the more than 30 nursing homes involved, he added.

In December, federal officials said Georgia Medicaid should return more than $100 million in payments made to a group of nursing homes. The feds said these payments were not permitted under the program’s regulations.

The payments were made in fiscal years 2010 and 2011. But CMS also asked Georgia to return any similarly inappropriate payments for more recent fiscal years as well. full story

Feds want $100 million back in Medicaid flap

Federal officials want Georgia Medicaid to return more than $100 million in payments made to nursing homes. The feds say these payments were not permitted under the program’s regulations.

nhomesThe payments were made in fiscal years 2010 and 2011. But the Centers for Medicare and Medicaid Services also asked Georgia to return any similarly inappropriate payments for more recent fiscal years as well.

In a Dec. 8, 2014, letter and report to Georgia about the nursing home problem, regional CMS officials told the state Medicaid agency to “cease and desist this unallowable funding mechanism immediately.’’

Georgia officials said in an email to Georgia Health News that the activity has been halted, but that the state has not paid back the funds to the federal government.

The nursing home money is not the only Medicaid funding that has Georgia grappling with federal health officials.   full story

Medicaid care coordination put back on hold

The state has shelved its attempt to coordinate care of Medicaid beneficiaries who are elderly or disabled.

Photo of the Georgia Capitol BuildingThe Georgia Department of Community Health said Tuesday that it was not proceeding “at this time’’ with soliciting bids from potential vendors to operate the program.

The agency’s statement, made in an email to GHN, follows the General Assembly’s removal of $12 million in state funds, intended for the startup of the program, from the fiscal 2016 budget proposed by Gov. Nathan Deal.

Community Health, though, denied that the removal of startup funds drove its decision to halt the contracting process. full story

Key panel gives doctors a pay raise for Medicaid

A state Senate panel gave Georgia primary care doctors a potential financial boost Wednesday, putting millions of dollars into the state budget for a pay raise to deliver services to Medicaid patients.

The Senate Appropriations Committee passed a budget that awards $5.9 million in state funds for a Medicaid pay raise to ob/gyns, and $13.6 million to internists, pediatricians and family medicine physicians.

Dr. Evelyn Johnson of Brunswick says the pay raise will keep some doctors from closing their practices.

Dr. Evelyn Johnson of Brunswick says the pay raise will keep some doctors from closing their practices.

Those amounts surpass the House’s allocation of $3 million and $1.6 million to the respective groups.

The state funds would be matched by federal money.

The doctors can’t count on the raise yet. The Georgia budget has a ways to go before being finalized. full story

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