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WakeMed Remediates Medicare Inpatient/Outpatient Billing Errors

RALEIGH, N.C. (December 19, 2012) – WakeMed Health & Hospitals’ Board of Directors has entered into a settlement agreement with the Federal Government related to inaccurate billing associated with the classification of inpatient stays.

The $8 million settlement, the bulk of which represents penalties, is a result of patients being classified as inpatient versus outpatient in the absence of an appropriate physician order. Inpatients are generally expected by policymakers to require a greater expenditure of hospital resources. It is important to note that all billed services were provided and that none of the billing issues had any impact upon patient care. In fact, for all patient encounters, the billing status of the patient did not affect or change the care patients received and did not result in higher costs for patients.

“WakeMed is one of the best hospital systems in the country and is an organization with great integrity. This settlement agreement is the result of billing errors made interpreting Medicare rules and regulations,” commented Tom Oxholm, chair, WakeMed Board of Directors. “We take full responsibility for the mistakes and regret that errors were made.”

As a result of these billing errors, which occurred between 2003 and 2010, WakeMed has invested in numerous remedial measures to ensure compliance, including training, revamping the admissions process, reviewing all claims prior to submission, and engaging additional independent auditors. In fact, in an effort to comply, WakeMed previously remitted $1.2 million identified via internal audits. This amount will be deducted from the $8 million total.

“We always strive to submit accurate, compliant bills to patients, insurance companies, Medicaid, and Medicare,” commented Dr. Bill Atkinson, president and CEO. “This process has encouraged us to review our processes and procedures and build additional checks and balances to ensure that we are submitting the most accurate billing information in compliance with all rules and regulations.”

The settlement agreement has been entered into by WakeMed, the Office of the Inspector General of the U.S. Department of Health & Human Services, the Civil Division of the U.S. Department of Justice and the U.S. Attorney’s Office for the Eastern District of North Carolina. The settlement agreement includes a two-year deferred prosecution agreement and a five-year corporate integrity agreement.


Questions about settlement can be directed to WakeMed’s Corporate Compliance Department at (919)350-7401 or emailed to info@wakemed.org.

About WakeMed Health & Hospitals
WakeMed Health & Hospitals is a private, not-for-profit health care organization based in Raleigh, N.C. The 870-bed system comprises a network of health care facilities throughout Wake and Johnston Counties. Centers of Excellence include cardiac and vascular care, women’s and children’s services, physical rehab, emergency and trauma, orthopedics, neurosciences, home care and numerous wellness and community outreach programs. WakeMed’s team of 8,300 employees, 1,000 volunteers and more than 1,000 affiliated physicians serve the residents of North Carolina using the most advanced technologies to ensure the finest in health care. For more information, visit www.wakemed.org.


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