John D. Archbold Memorial Hospital Inc., Thomasville, Georgia, has paid the US $13.9 million to settle Medicaid fraud allegations.

A December 22, 2010 U.S. Department of Justice (DOJ) press release says the hospital submitted incorrect and false claims to Georgia’s Medicaid program, from November 2002 to July 2008.

By claiming to the Georgia Department of Community Health, the state agency administering the state’s Medicaid program, that it was a public hospital for Medicaid, the hospital received a greater amount of Medicaid funds than it was entitled to.

According to Medicaid rules, participation in the Medicaid Upper Payment Limit (UPL) program is limited to public hospitals. Public hospitals also receive what is called additional Disproportionate Share Hospital (DSH) funds not available to private hospitals.

Archbold Memorial falsely represented itself as a public hospital, contrary to its certification with the Georgia Department of Community Health as a private hospital. The deception netted the hospital millions of dollars from the UPL and DSH funds, all of it illegally.

The hospital was sued initially by Wesley Simms, M.D., acting as a whistleblower under terms of the False Claims Act. The Act allows citizens to file suit on behalf of the government and share in any proceeds recovered by the legal action. Simms will receive $695,151 as his share of the settlement.

The False Claims Act has strengthened the government’s abilities to uncover, prosecute, and seek to recover funds from Medicaid fraud perpetrators. In fact, a total of nearly $6.8 billion has been recovered in this way since January, 2009.

"The U.S. Attorney’s Office will continue to use the False Claims Act to protect programs like Medicaid, which rely on the honesty and accuracy of information provided by program providers to determine the amount of money paid by the United States," said Sally Quillian Yates, U.S. Attorney for the Northern District of Georgia in Atlanta.

Have information on Medicaid Fraud?

If you have information about Medicaid fraud, contact the Medicaid Fraud Reporting Center for a confidential claim evaluation today. You may report Medicaid fraud by completing the form on this page, or by calling our Medicaid Fraud Hotline at 1-800-934-2921.