The subsurface conditions for a proposed six-story $94M medical facility in Knoxville, Tennessee, consisted of a thick clay layer overlying an irregular weathered limestone bedrock surface. Because the design loads were significant and because of the sinkhole risk associated. In an effort to save both time and money, the authors and other members of the project design team developed a combination ground improvement program to allow support of the medical facility on conventional shallow foundations. The combination ground improvement program consisted of (1) cap grouting the rock surface to significantly reduce the sinkhole risk, and (2) construction of Geopier elements to reinforce and stiffen the soils immediately below the planned shallow foundations.