Wake Forest Baptist, federal government settle Medicare claim at $757,585
(The Center Square) – Wake Forest University Baptist Medical Center has agreed to a six-figure settlement with the federal government to resolve overpayments for Medicare claims.
The settlement, which does not include an admission of wrongdoing by WFBMC, involves overpayment of $757,585, the U.S. Attorney’s office announced Tuesday. Prosecutors said it resulted from improper documentation at the Wilkes Medical Center Skilled Nursing Unit, which was acquired by Wilkes Medical Center in July 2017.
“The United States contends that between January 1, 2015 and September 30, 2019, the Wilkes Medical Center submitted or caused to be submitted claims to Medicare for physical and occupational therapy services provided to patients at the Wilkes SNU that were not supported by documentation,” according to a release.
Federal officials launched an investigation in response to a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act, which allows private parties to sue on behalf of the government and share in any recovery.
Wake Forest Baptist in Winston-Salem, operating under the Charlotte-headquartered Advocate Health umbrella, cooperated with federal officials and took remedial action to address the issues discovered during the investigation, the release said.
“Medical facilities that submit claims to Medicare must ensure that those claims are supported by documentation and are medically necessary,” said Sandra Hairston, federal attorney for the Middle District of North Carolina. “This office is dedicated to protecting federal health care programs and ensuring that the government does not pay for unsupported claims.”
The case was initially filed by Tonya Cook, an employee at Wake Forest Baptist, alongside the state of North Carolina and the U.S. government against WFBMC, North Carolina Baptist Hospital, the town of North Wilkesboro, Wake Forest Baptist Health, and WRMC Hospital Operating Corporation on April 30, 2020.
It centered on claims Wake Forest Baptist “systematically caused its physical therapists and other employees to repeatedly overcharge Medicare for group therapy sessions at the decidedly higher individual therapy rates … and to classify patients into higher” paying reimbursement categories, according to court records.
The case was handled by the U.S. Attorney’s Office for the Middle District of North Carolina with help from the Office of Inspector General for the U.S. Department of Health and Human Services.
