Bad bill diagnosis

December 20, 2012 

One important factor in the embarrassing $8 million settlement WakeMed had to make with the federal government is that this was not a case of anyone putting ill-gotten gains into his or her own pocket. Instead, the extra money from charges to Medicare for heart patients who stayed overnight went to WakeMed’s coffers.

Only, it turns out, a lot of them didn’t stay overnight. So Medicare overpaid. Federal prosecutors investigated (should the hospital’s own auditors have discovered this long ago?) and were not happy. Bill Atkinson, the hospital system’s president and CEO, seemed to blame the situation on a misinterpretation of complicated Medicare rules. Doubtless Atkinson, loyal to his employees, believes that.

But he did sign off on a multimillion-dollar settlement. And people either spend the night or they don’t, a fact that’s not really open to interpretation. So something was going wrong here. The hospital says it has taken measures to see that this doesn’t happen again.

That’s good, because U.S. Attorney Thomas Walker sounded unhappy when he said, “This case will serve as a reminder that hospitals, just like individual health care providers, will be held accountable for their actions.” He noted that Medicare depends on providers to submit accurate and honest bills.

Hospitals can cure many things, but when something is wrong at the hospital itself, the remedy must come from the outside. In this case, federal auditors and Walker’s office provided the right assessment and treatment.

WakeMed, a public hospital before its conversion to private not-for-profit in 1997, has served county citizens and those from other counties for over 50 years. This mistake, and it was a big mistake, does not diminish that history.

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