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Medicare Inpatient/Outpatient Billing Errors Statement Clarification

For Additional Information:
Deb Laughery
WakeMed Health & Hospitals
Public Relations
(919) 350-8612
dlaughery@wakemed.org


RALEIGH, N.C. (January 14, 2013) – WakeMed Health & Hospitals is issuing this press statement to clarify any prior oral or written statements regarding WakeMed’s global settlement of issues related to inpatient billing for zero or one-day patient stays. Some of WakeMed’s prior statements were made quickly to respond the Government’s press release of December 19, 2012. To the extent those prior statements created any ambiguity between WakeMed’s position and the global settlement documents, WakeMed makes this clarification. In an abundance of caution, WakeMed confirms that it has agreed to a settlement with the United States as set forth in the Deferred Prosecution Agreement and further confirms that the Statement of Facts is true and accurate.

To the extent any prior statements by WakeMed might be interpreted to indicate that WakeMed believes nobody has been prosecuted in this matter, WakeMed makes the following clarifications. First, WakeMed understands that the Criminal Information that the Government filed in this case charges WakeMed with federal crimes. Second, WakeMed also understands that the Deferred Prosecution Agreement in this case means that the Government has deferred its prosecution of WakeMed for a period of two years, and, when WakeMed complies with all portions of the global settlement, the Government will dismiss the Criminal Information against WakeMed at that time. Finally, WakeMed further understands that there are no provisions in the global settlement documents that state that the Government has agreed not to prosecute any individuals.

To the extent any prior statements by WakeMed might be interpreted to indicate that the Medicare requirements relevant to this case changed during the time frame of the Government’s investigation, WakeMed clarifies that it understands those requirements did not change during this time. During this time period, WakeMed confirms that: it had access to and was aware of the relevant Medicare requirements, which state that a physician is responsible for deciding whether a patient should be admitted as an inpatient; it was at all times bound by those requirements; WakeMed had policies and procedures that confirmed the physician’s order determined whether the patient status at WakeMed was inpatient or outpatient; its supervisor responsible for the Patient Access Staff knew of the relevant Medicare requirements and was obligated to ensure that staff complied with Medicare requirements and with WakeMed’s own policies; WakeMed engaged in practices that resulted in WakeMed billing for inpatient services when WakeMed either did not possess an order supporting that billing status or WakeMed billed the matter as inpatient when the physician’s order designated the patient as outpatient.

To the extent any prior statements might be interpreted to indicate that WakeMed believes that there were only 150 cases that potentially involved the practice of admitting patients without orders, admitting patients in a way that conflicted with orders, or marking physician orders as inpatient admissions without prior consultation with the physician of record, WakeMed retracts any such statement. WakeMed understands that the Government’s investigation was conducted by randomly sampling and analyzing claims from various time periods, and that the universe of claims from which the samplings were drawn far exceeded 150 cases. The settlement figure reached in this case was derived from, among other things, an extrapolation from findings resulting from the examination of approximately 150 cases.