WellStar Medicaid Repayment

Click "Read more>>" to view an Administrative Update from David Anderson, Executive Vice President of Human Resources/OL and Chief Compliance Officer.

Some of you may have seen news stories or heard from sources internally that WellStar recently returned $2.7 million to the State of Georgia Medicaid fund. I would like to explain the facts regarding this story.

First and foremost, the State concluded its investigation with no findings of fraud.

Second, in order to dispel rumors, I want to emphasize that this situation had absolutely nothing to do with the recent departures of Dr. Simone and Bonnie Wilson.

Each day, WellStar receives on average $3.5 million in payments from various sources, including commercial insurers, and government payers like Medicare and Medicaid, under sometimes very complex reimbursement formulas. As a result, on almost every day, WellStar is, at times, underpaid and overpaid.  When WellStar discovers it was underpaid, we seek additional payment. When we find WellStar was overpaid, we strive to promptly make refunds to the payer.

The recently reported Medicaid refund of approximately $2.7 million was the result of overpayments that four WellStar hospitals received from the State Medicaid program over a four year period ending last year. These overpayments occurred largely as a result of a glitch in the State Medicaid payment system. When billing Medicaid, WellStar always includes previous Medicare payments for the account. In this case, due to the design flaw in Medicaid's claims processing software, the Medicare payments were dropped from the claim, which resulted in the overpayments. Unfortunately, WellStar did not have adequate systems in place to detect these overpayments.

Upon learning of this potential billing issue from the State, WellStar immediately conducted an internal investigation and fully cooperated with the State. We also hired outside auditors to review this situation, and other government payments we receive. These auditors found no additional issues requiring repayments to any payers. WellStar also has implemented corrective measures to assess the accuracy of payments we receive from the State Medicaid program.

It is important to note that the State found no evidence of any intentional wrongdoing on the part of WellStar or any of its employees, and that the State's investigation of this issue at WellStar is part of a larger investigation including a number of other hospitals.

If you have any further questions, please let me know.


David Anderson
Executive Vice President of Human Resources/OL and Chief Compliance Officer
David.Anderson@wellstar.org