The state of Georgia reached a civil settlement agreement on April 23, 2015, with Grady Health System based on allegations that Grady incorrectly coded claims for neonatal intensive care unit (NICU) patients, resulting in overpayments by Georgia Medicaid. For more details, read the Georgia Attorney General’s press release announcing the settlement.
This case arose after an audit conducted by Myers & Stauffer, the Recovery Audit Contractor for the Georgia Department of Community Health, sparked an investigation by the Georgia Medicaid Fraud Control Unit in 2013. While no determination of liability has been established, Grady agreed to pay $2,950,000 to settle the claims. This settlement serves as a notable example of how children’s hospitals are not immune from these types of challenges and highlights the need for effective compliance programs and dedicated compliance resources at children’s hospitals.