Whistleblowing doctor to get $4 million for exposing healthcare fraud by hospital system
A whistleblowing doctor will be awarded $4.2 million for exposing alleged healthcare fraud by a Washington state-based hospital system, the U.S. Justice Department said April 12.
Providence Health & Services Washington fraudulently billed Medicare, Medicaid, and other federal healthcare programs for medically unnecessary neurosurgery procedures, federal investigators alleged. Providence, of Walla Walla, Wash., has agreed to pay $22.7 million to resolve the allegations.
It is the largest-ever healthcare fraud settlement in eastern Washington state, the feds said.
The case once again illustrates the key role whistleblowers play in protecting the financial integrity of the nation’s healthcare system, said Scott Williams, CEO of Ethic Alliance.
“It sometimes feels like fraudulent billing of Medicare has become the new national pastime,” said Williams. “Whistleblowers are critical to maintaining trust in a system as large as Medicare, and rewarding them for coming forward is a very rational economic model.”
Ethic Alliance is a for-profit corporation and law firm whose purpose is to empower, educate and protect whistleblowers, ensuring they receive the protection they need and the rewards they are entitled to under US law (the US government will typically reward whistleblowers 10%-30% of the amount recovered or sanctioned under various whistleblower laws), generating profits for investors while reducing corruption, fraud, theft, lying and cheating in our society.
Ethic Alliance protects whistleblowers through a secure, encrypted reporting and messaging platform, attaching the strong legal protection of attorney-client privilege from the moment a report is filed with us, and access to a network of specialty attorneys that have made careers protecting and supporting whistleblowers, and working with the US government to win whistleblower lawsuits.
Providence is a large healthcare and hospital system that operates 51 hospitals in seven western U.S. states, including Providence St. Mary’s Medical Center in Walla Walla.
Between 2013 and 2018, Providence St. Mary’s employed neurosurgeons publicly identified only as Dr. A and Dr. B.
“Providence St. Mary’s paid neurosurgeons based on a productivity metric that provided them a financial incentive to perform more surgical procedures of greater complexity. Between 2014 and 2018, Dr. A was one of the highest producing neurosurgeons in the entire Providence system. Between 2014 and 2017, based on the productivity metric, Providence paid Dr. A between $2.5 million and $2.9 million per year,” the feds say.
As part of the settlement agreement, Providence admitted that, during the time period in which Dr. A and Dr. B were employed at Providence St. Mary’s as neurosurgeons, Providence medical personnel articulated concerns that Dr. A and Dr. B (1) were endangering the safety of patients; (2) created through their surgeries an excessive level of complications and negative outcomes; (3) performed surgery on candidates who were not appropriate for surgery; and (4) failed to properly document their procedures and outcomes.
“Providence’s failure to ensure that Dr. A and Dr. B were performing safe and medically-appropriate surgery procedures, despite repeated warnings, put patients’ lives and safety at serious risk,” said Vanessa R. Waldref, the United States Attorney for the Eastern District of Washington, in a statement. “I am also gravely concerned that Providence’s decision not to report Dr. A or Dr. B to federal or state medical oversight bodies allowed both surgeons to simply resign from Providence and then continue to endanger patients at other hospitals.”
According to court documents, the case began in January 2020, when a whistleblower, identified only as the former medical director of neurosurgery at Providence-St Mary’s, filed a “qui tam” complaint under seal in federal court. When a whistleblower, or “relator,” files a qui tam complaint, the False Claims Act requires the United States to investigate the allegations and elect whether to intervene and take over the action or to decline to intervene and allow the relator to go forward with the litigation on behalf of the United States. The relator is generally able to then share in any recovery.
In this case, according to court documents, the United States intervened in the action in January 2022, and subsequently reached this settlement. Pursuant to the settlement agreement, the whistleblower will receive $4,197,734 of the total settlement amount.
Contact Ethic Alliance at info@ethicalliance.com
Related link: https://www.justice.gov/usao-edwa/pr/providence-health-services-agrees-pay-227-million-resolve-liability-medically
Photo by Martha Dominguez de Gouveia on Unsplash