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Hospital settles billing inquiry

Tampa General will pay the state $4-million for fraudulent charges billed to Medicaid, the attorney general says.

Published November 6, 2003

TALLAHASSEE - Tampa General Hospital will pay Florida $4-million for fraudulent charges it billed to Medicaid, Attorney General Charlie Crist announced Wednesday.

The settlement caps a two-year investigation by the state's Medicaid Fraud Control Unit. It is the second-largest agreement Crist's office has reached with a half-dozen hospitals for the same infraction, a Crist spokesman said.

"It ain't small stuff," Crist said.

The investigation involved a rule that used to let hospitals charge Medicaid, the state-federal health care program for the poor, for routine doctor visits in clinics. The state stopped paying for those visits in 1998, even though the federal government continued to pay for them under Medicare, the federal health care program for the elderly.

TGH didn't change its computerized billing system to reflect the change, so it continued to charge the state for Medicaid clinic patients, said hospital chief financial officer Steve Short.

"We really just made a mistake," Short said. "We understood the rule. We just didn't do due diligence" in ensuring the billing code had been deleted from the hospital's computers, Short said. "It just went on for a couple of years without anyone knowing about it."

Complicating things is the fact that Medicaid does pay for things like X-rays taken during those visits.

"You just can't charge for the office visit," Short said.

Tampa General has been negotiating the settlement with the state for about a year, so it's prepared to pay the fine, Short said.

The hospital has two clinics that see patients for nonemergencies.

Since taking office in January, Crist has made combatting Medicaid fraud a priority. He has cleaned house in the Medicaid Control Fraud Unit, an arm of his office that investigates abuse in the $12-billion program.

Of the $4-million Tampa General must pay back, $2.9-million is for the faulty charges and $1.1-million covers the fine and the costs of the state investigation. Investigators looked at charges Tampa General filed under the old rule from 1998 through part of 2001 and found that 99 percent of the sample charges did not qualify for Medicaid reimbursement.

Crist said he thinks the billing problem has been fixed.

"Tampa General is a fine hospital and has performed Medicaid services for several years," Crist said.

"We are confident that their billing procedures have been corrected to follow proper guidelines, but we will continue to monitor their activities," he added.

Jackson Memorial Hospital in Miami settled with the state for $7.34-million for continuing to charge Medicaid for routine visits after 1998, according to Crist's office.

Crist said his office has 562 active cases, and 110 of those involve hospitals.

[Last modified November 6, 2003, 03:47:10]

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