Wakemed deal OK’D

Judge says im­pact of clos­ing hospi­tal too dras­tic

Modern Healthcare - - LATE NEWS - Joe Carl­son

Afed­eral judge al­lowed North Carolina’s WakeMed Health and Hos­pi­tals to take an un­usual deal to avoid a crim­i­nal trial be­cause the risk of clos­ing down a Raleigh, N.C., hospi­tal is too per­ilous for pa­tients and work­ers.

The not-for-profit cor­po­ra­tion was charged in De­cem­ber with one count of mak­ing ma­te­ri­ally false state­ments in or­der to in­crease Medi­care re­im­burse­ments—an un­prece­dented crim­i­nal charge for a com­mu­nity hospi­tal, ac­cord­ing to pros­e­cu­tors and numer­ous le­gal ex­perts.

Hospi­tal of­fi­cials ad­mit­ted in court records that staff mem­bers in the Wake Heart Cen­ter on the sys­tem’s Raleigh cam­pus rou­tinely ig­nored and fab­ri­cated physi­cian or­ders, and as a re­sult billed Medi­care for in­pa­tient care when car­diac pa­tients didn’t stay overnight in the hospi­tal.

The is­sue first came to light af­ter a re­view by a Zone Pro­gram In­tegrity Con­trac­tor, Ca­haba Safe­guard Ad­min­is­tra­tors, found that WakeMed had the high­est per­cent­age of so-called “zero-day stays” in the state, and one of the high­est such rates in the na­tion, be­tween 2003 and 2006. Sub­se­quent in­ves­ti­ga­tions by hospi­tal staff and pros­e­cu­tors found wide­spread ir­reg­u­lar­i­ties.

Hospi­tal ex­ec­u­tives signed an $8 mil­lion civil set­tle­ment that in­cluded False Claims Act penal­ties and a five-year cor­po­rate in­tegrity agree­ment.

Pros­e­cu­tors also charged the hospi­tal with a felony, which would re­sult in WakeMed los­ing its abil­ity to get Medi­care pay­ments if found guilty, but then agreed to al­low the sys­tem to en­ter a de­ferred-pros­e­cu­tion agree­ment in which the charge would be dropped if the sys­tem doesn’t re­of­fend within two years. Pros­e­cu­tors said in court fil­ings that cut­ting off the sys­tem’s abil­ity to be paid for treat­ing Medi­care pa­tients “would likely re­sult in WakeMed’s demise.”

U.S. District Judge Ter­rence Boyle ini­tially re­fused to ac­cept the agree­ment, how­ever, say­ing it was a “slap on the hand” for an or­ga­ni­za­tion he called “too big to fail,” ac­cord­ing to news ac­counts from the hear­ing.

The de­ci­sion forced hospi­tal of­fi­cials and pros­e­cu­tors to sub­mit de­tailed briefs and at­tend a sec­ond hear­ing Feb. 5 to ex­plain why the agree­ment was ap­pro­pri­ate. On Feb. 8, Boyle ac­cepted the terms.

“The court has con­sid­ered the threat that the pro­vi­sion of es­sen­tial health­care to WakeMed’s pa­tients would be in­ter­rupted and that the needs of the un­der­priv­i­leged in the sur­round­ing area would be dras­ti­cally and in­hu­manely cur­tailed should de­fen­dant be forced to close its doors as a re­sult of the in­stant pros­e­cu­tion,” Boyle wrote.

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