St. Joseph's/Candler statement on Medicaid settlement

Corrections to Medicaid and Medicare billing are part of the normal business cycle in the healthcare industry. It is important that the state and hospitals continually audit these complex programs to correct overpayments and underpayments.

For example, in the past, St. Joseph's/Candler has received lump payments after we were underpaid for Medicaid and Medicare coverage.

In this case, the state began an investigation at a handful of Georgia hospitals after finding an unusual pattern of claims, mostly for $1,000 or less. St. Joseph's/Candler was contacted in March and cooperated fully with the investigation.

  • It was determined that overpayment errors had occurred on a specific type of claim.
  • The errors occurred due to a glitch in the state's computer system, which created the overpayment.  The computer system deleted information from the claims without anyone's knowledge, resulting in an overpayment from Medicaid.
  • Given the software available at the time, there was no way for SJ/C to know that Medicaid had overpaid, especially given the small dollar amount of the claims.
  • SJ/C was able to document for the state discrepancies in the Medicaid and Medicare computer billing process that led to the overpayments to St. Joseph's/Candler.
  • While we are in total agreement that the funds should be repaid, the error in payment was outside of our control and is the same issue that has been experienced by other hospitals throughout the state.
  • The state found no intent to defraud Medicare/Medicaid.
  • The claims affected by the computer glitch amounted to less than 1 percent off all of SJ/C's Medicare/Medicaid claims over a three year period of time.
  • St. Joseph's/Candler has recently installed new software not available during the years in question to assist with identifying problems like this in the future.