Medicare Compliance & Reimbursement

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 Agency for Health Care Administration, that it wasn't allowed. The confusion arose out of rule changes that were implemented in the late 1990s, according to news reports. The former AHCA employee who filed the case will collect about $1.4 million, the Associated Press reports.

Lesson learned: Hospitals should make sure they have a handle on billing procedures for outpatient clinics.