Exiting the Raleigh courtroom of U.S. District Judge Terrence Boyle on Thursday, federal prosecutors and defense attorneys for WakeMed must have felt like they’d gone a few rounds with Muhammad Ali – only their bruises weren’t from fighting each other. Disgusted with a Medicare fraud settlement between the U.S. Attorney’s Office and the hospital, Boyle rejected the effort and gave everybody a tongue-lashing they’ll not soon forget.
At last, it seems, someone has articulated in no uncertain terms the public sentiment about the settlement and others like it.
Basically, federal investigators found that WakeMed had billed Medicare for millions of dollars in overnight stays in its heart center by patients who didn’t stay overnight. This turned up in 2007 after auditors for federal regulators couldn’t reconcile data with interviews they conducted with WakeMed managers.
Federal officials subpoenaed records and ran an exhaustive investigation. They contend that WakeMed’s “Patient Access” staff ignored doctors’ orders and that nurses assumed the task of deciding whether Medicare should be billed for more expensive overnight services.
The outcome, the one that enraged Boyle, was an $8 million fine and a deferred prosecution. Individuals were not charged.
In his remarks, Boyle noted that he’d put people in prison for insurance fraud, whereas the settlement with WakeMed appeared to be a “slap on the hand” for a “too big to fail” corporate giant. Medicare and Medicaid money would be at risk if the hospital were convicted of a felony, Boyle said, which could put WakeMed out of business.
The judge further said that the “victims” in the case were “every American wage earner and every American citizen.”
“It’s very difficult for society and the court to differentiate between the everyday working Joe or Jane who goes to prison and the nonprofit corporate giant who doesn’t go to jail, who gets a slap on the hand and doesn’t miss a beat,” he said, noting a national increase in health care fraud cases.
In a way, the judge’s comments could be applied to the Wall Street collapse of almost five years ago, when the public felt helpless in the face of financial houses that played by their own rules. As with Boyle’s view of the WakeMed case, people were angry that no one in the big banks was held accountable in a meaningful way.
Boyle also was unhappy with the fact that no one from WakeMed appeared in court to answer his questions. Given Boyle’s reputation as a by-the-book, demanding judge who goes into every case well-informed, that indeed seemed a bad choice on WakeMed’s part.
The judge clearly thought prosecutors made an inferior deal and didn’t defend it very well.
It should be said that WakeMed has been a valued asset to the community and an excellent health care organization in its 52 years. But this case is a cautionary note to all health care organizations.
Boyle is going to reconsider the case Feb. 5. It’s safe to assume WakeMed officials will attend.
