WakeMed Health and Hospitals' 647-bed campus in Raleigh, N.C., has come under a five-year corporate integrity agreement with the HHS, even though the hospital is still waiting for word from a federal judge on whether it can settle a felony charge of Medicare outpatient upcoding.
WakeMed Health and Hospitals was charged Dec. 19 with allowing its personnel to ignore and in some cases fabricate physician orders for patients in the Raleigh campus' cardiac department so that the hospital could charge Medicare for costly hospital treatment, even though the heart unit has no acute-care beds.
Civil cases involving upcoding are relatively common for hospitals, but numerous healthcare attorneys said they believed it was the first instance of a hospital being criminally charged for making material false statements to overbill Medicare.
Executives at WakeMed attempted to admit wrong-doing as part of a deferred prosecution agreement that would erase the criminal charge after two years of compliance. However, a federal judge on Jan. 17 rejected the proposed agreement as “a slap on the hand.”