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Judge questions WakeMed fraud plea agreement

Posted January 17, 2013

WakeMed

— A federal judge criticized prosecutors Thursday for not pursuing a criminal case against WakeMed for fraudulent Medicare billing practices.

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 last month to pay $8 million to settle the federal investigation. Prosecutors charged the hospital system with making material false statements relating to health care matters and with aiding and abetting but 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.

Instead of approving the settlement during a Thursday court hearing, U.S. District Judge Terrence Boyle asked prosecutors why WakeMed and some of its employees weren't indicted.

Prosecutors said they were confident they would prevail if the case went to trial, but a conviction could devastate WakeMed by possibly barring them from participating in the Medicare and Medicaid programs.

Boyle said it's not right to use a "too big to fail" argument for the hospital system, noting individuals charged with similar crimes are sent to prison. Everyone who pays into the Medicare system was hurt by the fraudulent billings, he said.

Instead of deferring prosecution, he said, authorities could have obtained a guilty plea and deferred sentencing.

Prosecutors argued that the settlement agreement serves as a deterrent to others, but Boyle wasn't too happy with the deal and delayed a decision in the case for two weeks.

Dr. Bill Atkinson, WakeMed president and chief executive, said last month there was never any intent to defraud the government. He attributed the fraudulent billings to mistakes in interpreting complex Medicare rules.

WakeMed backtracked on some of those comments this week, issuing a statement noting that it knew the rules and was bound to follow them.

The hospital system also corrected Atkinson's initial statement that fewer than 150 cases included questionable billing. Prosecutors said they may never know the exact number of cases involved.

WakeMed has already 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.

Federal regulators also 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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  • dollibug Jan 18, 7:53 p.m.

    Sounds like a lot of CORRUPTION AND COVER UP GOING ON....and no one is doing anything about it....there should be someone in charge of what happened. What are they doing....blaming the devil?

  • MountaineerAsh Jan 18, 6:59 p.m.

    What about all the charity care WakeMed provides that they Never get reimbursed for at all? No one seems to care about that.

  • djofraleigh Jan 18, 6:52 p.m.

    Wake Med is the largest employer in Wake County. Imagine it having to close!!!

  • cblackman Jan 18, 3:20 p.m.

    I can guarantee, after working at Wake Med for 5 years, that someone who makes 10-12 dollars per hour lost their jobs for this. And, they only did what they were TOLD to do....

  • KermitDFrog Jan 18, 2:58 p.m.

    This isn't limited to WakeMed. Across the country there are hospital districts and private practices doing the exact same thing. Even the large pharmacy chains are in on the action.

  • KermitDFrog Jan 18, 2:53 p.m.

    We can easily demonize the "welfare mom". When you wear a nice suit and steal millions for a living, you're heralded and shielded. I'm sure all those in charge got nice fat bonuses for increasing revenue.

  • zile1porkey Jan 18, 2:03 p.m.

    FINALLY A GOOD JUDGE IF I HAD MY OWN BUSINESS AND DID WHAT WAKE MED DID I WOULD BE IN JAIL HE IS CORRECT THEY NEED TO CHARGE SOMEONE OF COURSE THEY CAN PAY THE MONEY BACK BUT WHY DID THEY SETTLE BECAUSE THEY KNEW THEY HAD FRAUDED THREE TIMES WHAT THEY ARE PAYING INDICTED THEM CRIMINAL CHARGE SOMEONE TO STOP THIS.

  • buford Jan 18, 1:49 p.m.

    None of the employees involved received any benefit. - superman

    True, but unfortunately the employees will suffer for this. Three years ago WakeMed was broke and there were no raises or bonuses...now all of a sudden they are buying up every hospital and practice around...where did the $$$ come from?

  • golorealist Jan 18, 1:46 p.m.

    my thought process as i read this article:

    "Dr. Bill Atkinson, WakeMed president and chief executive, said last month there was never any intent to defraud the government. He attributed the fraudulent billings to mistakes in interpreting complex Medicare rules."

    huh? either patients stayed overnight and medicare should be billed, or they didn't stay and medicare should not be billed. the rules are pretty cut and dry there. there's no grey area in the rules pertaining to charging for hospital stays.

    "WakeMed backtracked on some of those comments this week, issuing a statement noting that it knew the rules and was bound to follow them."

    yeah. that's what i thought.

    lying to try to make yourself look better when you're already in trouble for fraud isn't a wise move.

  • goncampn2 Jan 18, 1:44 p.m.

    Wake Med also needs to be investigated for the way they handle patients outstanding medical bills. Twice I have used their services and after my insurance settled bill I was responsible for the remainder. I scheduled a payment plan and was on time for every payment except when the holiday mail did not get my payment to them.They immediately turned it over to collections which by the way they own. Don' understand that!I paid/mailed the bill 5 days before it was due. It took the post office 6 days to deliver the payment.I tracked it. By the way I live in Apex less than 10 miles from Wake Med on Tryon Rd.

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