North Carolina's WakeMed Health and Hospitals will ask a judge today to approve a settlement that includes an agreement to avoid prosecution, an extremely rare case of a health system charged criminally over Medicare claims.
But officials for the health system may have to convince the judge that they are truly admitting to the wrongdoing, a condition of the agreement.
Prosecutors in the U.S. attorney's office in Raleigh, N.C., filed a charge against Raleigh-based WakeMed in a criminal information document (Attachment A of the deferred prosecution agreement (PDF)) alleging the system treated cardiac patients in its outpatient heart center but then billed Medicare as though the patients had stayed in inpatient acute-care beds on its Raleigh campus. The information, filed Dec. 19, alleges that WakeMed staff then fabricated physician orders for inpatient care, and received higher reimbursements than it was entitled to between 2000 and 2008.
WakeMed also agreed to pay $6.8 million in a related civil settlement. Before the U.S. attorney's office began its investigation, WakeMed repaid $1.2 million in inappropriate payments indentified in an internal inquiry prompted when a CMS contractor noted anomalies in the claims.