Providence Health & Services Washington (Providence) has agreed to pay $22,690,458 to resolve allegations that it fraudulently billed Medicare, Medicaid, and other federal healthcare programs for medically unnecessary neurosurgery procedures. Today’s joint settlement between Providence, the United States, and the State of Washington, which administers Washington’s Medicaid program using a combination of state and federal funding, is the largest-ever healthcare fraud settlement in the Eastern District of Washington. Providence is a large healthcare and hospital system that operates 51 hospitals in seven western US states, including Providence St. Mary’s Medical Center (Providence St. Mary’s) in Walla Walla, Washington.
Between 2013 and 2018, Providence St. Mary’s employed neurosurgeons identified in the Settlement Agreement 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. Today’s settlement resolves allegations that Providence falsely billed Medicare, Washington State Medicaid, and other federal healthcare programs for deficient and medically unnecessary neurosurgery procedures performed by Dr. A and Dr. B.
