Local News

Judge OKs WakeMed fraud settlement

Posted February 8, 2013

— After twice balking at a proposed settlement that would let WakeMed escape with only a fine for fraudulent Medicare billing practices, a federal judge signed off on the deal Friday.

Federal investigators said WakeMed routinely billed Medicare for inpatient stays by people who had undergone cardiac treatments, even if they were discharged the same day as the treatment and never spent a night in the Raleigh hospital.

Physician orders to discharge patients also were frequently overwritten so Medicare could be billed, according to federal court documents.

WakeMed agreed in December to pay $8 million to settle the investigation. Prosecutors charged the hospital system with making material false statements relating to health care matters and with aiding and abetting, but they deferred prosecution of the case for two years.

If WakeMed complies with all provisions set out in the settlement agreement during that time, the charges would be dismissed.

U.S. District Judge Terrence Boyle twice declined to approve the settlement, criticizing prosecutors for not pursuing a criminal case against WakeMed or any of its managers. But he finally relented Friday and signed off on the deal, saying convicting WakeMed could hurt patients by barring the hospital from participating in the Medicare and Medicaid programs.

"The court has considered the threat that the provision of essential healthcare to WakeMed's patients would be interrupted and that the needs of the underprivileged in the surrounding area would be drastically and inhumanely curtailed should defendant be forced to close its doors as a result of the instant prosecution," Boyle wrote in his ruling. "Accordingly, after weighing the seriousness of defendant's offense against the potential harm to innocent parties that could result should this prosecution go forward, the court has determined that a deferred prosecution is appropriate in this matter."

Prosecutors have said they are confident they would have prevailed if the case went to trial, but they said settlement serves the public interest.

As part of the settlement, WakeMed has hired a firm to conduct independent compliance audits, has revised its billing policies and procedures and has reworked its executive and board structure to place more emphasis on reporting compliance.

Also, federal regulators will monitor WakeMed's practices regarding Medicare for five years as part of a corporate integrity agreement. The agreement spells out the hospital's conduct for submitting claims, training employees and reviewing policies and sets up a method for workers to disclose any future problems with Medicare billing.

40 Comments

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  • superman Feb 12, 11:19 a.m.

    The hospital benefited and as a result your bill was lower. Now they just going to increase their charges to your bill and you going to pay the fine. The fine that you support is now going to be paid out of your pocket.

  • superman Feb 12, 11:15 a.m.

    Closing Wake Med would be devasting to Wake County. Thousands of people would be without care, thousands would be out of work, business would no longer be able to sell to them. I am glad some of you like the fine and maybe even think it should have been higher. Use your brain--just who do you think will be paying the fine. The patients will have it added to their bill. It is going to increase the hospital expenses. The money collected went into the bank for the hospital. My wife and I have both been patients at Wake Med several times. We always found the staff and the patient care excellent. Can you imagin closing every Wake Med facility? Where do you think the people will go. The emergency room is always packed with people.

  • vincentwilliam794 Feb 11, 1:00 p.m.

    It never mentioned if any doctors were involved. just saying

  • marciamal1 Feb 11, 12:57 p.m.

    I never liked this hospital and still don't - the staff was just so rude and inconsiderate - i couldn't believe how I walked into an emergency room and was greeted unfairly by the receptionist - that was 3-4 years ago and i haven't stepped one foot into that hospital again. Never will - I'd rather get treated at Rex Hospital - much better experience.!~

  • jacksun48 Feb 11, 12:47 p.m.

    Did anybody get fired? Probably not...business as usual. They'll find another way to steal money. Lack of character doesn't matter.

  • itlsss Feb 11, 10:45 a.m.

    Boyle, lot of noise, no action!

  • Rebelyell55 Feb 11, 9:20 a.m.

    While it's certain that someone got off from possible jail time, I do understand the judge's ruling and glad it was added into the article so people would understand.

  • lwe1967 Feb 8, 7:55 p.m.

    What made him change his mind? Is there a pay off here? Just wondering?

  • junkmail5 Feb 8, 7:41 p.m.

    People do not understand that if you are prosecuted for Medicare/Medicaid Fraud, NOT convicted. You cannot take care of ANY Medicare/Medicaid patients at all. Who gets hurt if WakeMed doesn't accept Medicare or Medicaid? EVERYONE in Wake County-Dazd N Confused

    You know what? There's other hospitals.

    By letting them just pay a fine, almost certainly a smaller amount than they stole, what reason do they, or any other hospital, have to simply not continue defrauding people?

    "Man! if we get caught we only get to keep HALF the money we stole!"

  • Uhavenoclu Feb 8, 7:33 p.m.

    I've been and lived in many states and NC has to be the most criminal state there is,not from the people but from the "Respected",corporations and politicians.........

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