The settlement follows a six-month investigation by the Georgia Medicaid Fraud Control and the Department of Community Health into WellStar’s billing for “cross-over” claims, which are claims made for patients who are enrolled in both Medicare and Medicaid. Medicare acts as the primary coverage, with Medicaid functioning as the secondary insurance, and Medicaid has a cap on the amount of reimbursement that a hospital can receive. The investigation suggested that WellStar filed claims which did not reflect the full amount of Medicare prior payments, allowing WellStar to receive excessive Medicaid reimbursements.
Under the terms of the agreement, WellStar and its hospitals denied any wrongdoing, but agreed to pay the Georgia Department of Community Health a lump sum of $2,728,318 to settle all possible claims related to the billing errors. WellStar also agreed to pay the state $10,000 to defray the costs of its investigation. WellStar cooperated fully with the investigation and implemented corrective actions to ensure that similar billing problems do not reoccur, according to the report.
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