WellStar agrees to $2.7 million settlement with state

By Carrie Teegardin

The Atlanta Journal-Constitution

WellStar Health System has agreed to pay $2.7 million to settle allegations that it improperly billed the state Medicaid system, Attorney General Thurbert Baker announced Monday.

The agreement came after a six-month state investigation which found that WellStar mishandled claims involving patients covered by both Medicare and Medicaid. WellStar filed claims that did not properly reflect payments it received from Medicare, allowing it to receive excessive payments from Medicaid.

Medicare covers elderly and disabled Americans. Medicaid provides insurance for low-income patients.

The allegations related to patients served at WellStar’s five hospitals: Cobb, Douglas, Kennestone, Windy Hill and Paulding.

"Upon learning from the state of this potential billing issue, WellStar immediately conducted an internal investigation and fully cooperated with the state," WellStar said in a statement.

The hospital system said a flaw in claims processing software caused the problem. "The State specifically found no intent to defraud," WellStar said.

WellStar admitted no wrongdoing as part of the settlement , according to the attorney general’s office. The investigation was conducted by the Georgia Medicaid Fraud Control Unit and the Department of Community Health, with assistance from an outside auditing firm.

“Reviews of other hospitals for similar billing issues are ongoing,” said Robert Finlayson, inspector general at the Department of Community Health, in a prepared statement.

The health system agreed to pay $2.7 million to settle the case and $10,000 to cover the costs of the investigation. The money will be returned to the state's Medicaid coffers.

Baker said in a statement that vigorous investigation of fraudulent billing cases is especially critical “when demand for Medicaid services is so high and public monies to pay for Medicaid are scarcer than ever.”