Wake Forest University Baptist Medical Center (WFBMC) has agreed to pay the government $754,585 to resolve an overpayment resulting from improper documentation at the Wilkes Medical Center Skilled Nursing Unit (“Wilkes SNU”), announced U.S. Attorney Sandra J. Hairston.

WFBMC acquired Wilkes Medical Center, including the Wilkes SNU, on July 1, 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.

The United States initiated its investigation when a whistleblower filed a lawsuit under the qui tam provisions of the False Claims Act, which allow private parties to bring suit on behalf of the government and to share in any recovery. WFBMC cooperated with the United States’ investigation and took remedial actions to address the issues discovered during the investigation.

“Medical facilities that submit claims to Medicare must ensure that those claims are supported by documentation and are medically necessary,” said Sandra J. Hairston, United States 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.”

This case was handled by the U.S. Attorney’s Office for the Middle District of North Carolina with assistance from Office of Inspector General of the United States Department of Health and Human Services.

The lawsuit is captioned United States ex rel. Cook v. Wake Forest Baptist Medical Center et al., No. 20-CV-386 (M.D.N.C.).  The claims settled by this agreement are allegations only, and there has been no determination of liability. The Settlement Agreement is not an admission of liability or wrongdoing by WFBMC.

Original source can be found here