9415

WellStar Health Systems agreed to pay 2.738 million in settlement of allegations about 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 found that WellStar filed claims which did not reflect the full amount of Medicare prior payments, allowing WellStar to receive excessive Medicaid reimbursements.