Providence agrees to pay $22 million in medical fraud case | Washington News

By NICHOLAS K. GERANIOS, Associated Press

SPOKANE, Wash. (AP) — Providence Health & Services Washington has agreed to pay $22.6 million to resolve allegations that its Walla Walla hospital fraudulently billed Medicare, Medicaid and other federal health care programs for medically unnecessary neurosurgical procedures, prosecutors said Tuesday.

Vanessa R. Waldref, United States Attorney for the Eastern District of Washington, and Bob Ferguson, Attorney General for the State of Washington, announced the settlement between Providence, the United States and the State of Washington, which administers Washington’s Medicaid program using a combination of state and federal governments. funding.

This is the largest health care fraud settlement ever recorded in the Eastern District of Washington, Waldref’s office said in a statement.

Providence operates 51 hospitals in seven western United States, including Providence St. Mary’s Medical Center in Walla Walla, Washington.

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The hospital did not immediately return phone calls seeking comment.

Between 2013 and 2018, Providence St. Mary’s employed neurosurgeons identified in the settlement agreement as Dr. A and Dr. B, Waldref’s office said in a statement.

Providence St. Mary’s pays neurosurgeons on a system that financially incentivizes them to perform more surgical procedures of greater complexity. Between 2014 and 2018, Providence paid Dr. A between $2.5 million and $2.9 million per year, according to the release.

Tuesday’s settlement resolves allegations that Providence falsely billed Medicare, Washington State Medicaid and other federal health care programs for flawed and medically unnecessary neurosurgical procedures performed by Dr. A and Dr. B.

“Patients with back pain and spinal cord injury deserve top-notch care from a provider who puts the patient first and who is not inappropriately influenced by how much they may charge for the procedure,” Waldref said.

“Providence’s failure to ensure that Dr. A and Dr. B were performing safe and medically appropriate surgeries, despite repeated warnings, seriously endangers the lives and safety of patients,” Waldref said.

“Patients trust their doctors that the care they receive is necessary, especially when they are having neurosurgery,” Ferguson said. “Performing unnecessary surgeries for profit is a betrayal of that trust.”

As part of the settlement agreement, Providence admitted that hospital employees raised concerns that Dr. A and Dr. B endangered patient safety, performed surgery on candidates who were not suitable for surgery and had not properly documented their procedures and results.

Providence admitted that while it ultimately placed Dr. B and Dr. A on administrative leave in February 2017 and May 2018, respectively, it allowed both doctors to resign while on leave and took no measure to report Dr. A. or Dr. B to the competent authorities.

As part of the settlement, Providence agreed to implement and maintain a number of quality of care and patient safety obligations. In addition, Providence must retain the services of outside experts to perform annual reviews of claims and clinical quality systems.

The case began in January 2020, when the former medical director of neurosurgery at Providence-St Mary Medical Center filed a lawsuit in federal court.

Copyright 2022 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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