Court affirms finding of overpayment to Medicaid provider based on single patient’s two hospital visits
Docket Number: 0000000 , Decision Date: July 11, 2023
Attachment: Click here to download the decision.
A Medicaid provider requested a hearing to contest an alleged $13,000 overpayment it received for two separate hospital admissions for the same patient. Pursuant to Georgia Medicaid policy, the Department of Community Health (DCH) prices two admissions of the same patient as one for “similar or related conditions” that occur within three days of each other. As such, the Court’s decision hinged on whether the patient’s two hospital admissions were both caused by “similar or related” conditions. After reviewing evidence and expert testimony from medical professionals on the potential causes of the patient’s admissions, the Court agreed with DCH that the patient’s two admissions were related to sepsis and upheld the overpayment findings.