tci Medicare Compliance & Reimbursement - 2003 Issue 29

Hospitals: Medicaid Official Blows Whistle On Provider

A Miami hospital will pay a whopping $16.8 million to settle a whistleblower suit filed by a former Florida Medicaid employee. According to U.S. Attorney Marcos Jimnez, Jackson Memorial Hospital agreed to pay the sum to resolve charges that it double-billed Medicaid. Prosecutors say both JMH and its outpatient clinics billed Medicaid under their respective provider numbers for the same covered service - a practice that's barred under a Florida Medicaid rule governing when physician fees and facility fees are allowable for hospital outpatient services. JMH discontinued the billing practice once it concluded, in consultation with Florida's...

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