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Court: United States District Court for the Western District of Washington (King County)
Plaintiff's Attorney: United States Attorney’s Office in Seattle
Description: Seattle, Washington civil litigation lawyers represented Defendant accused for fraudulently billing the federal government for health care services that were never performed.
The U.S. Department of Justice, the Washington State Attorney General’s Medicaid Fraud Control Division, accused United Wound Healing, P.S. with violating the False Claims Act by improperly billing Medicare and Mediaid for services provided to nursing homs and care facilities in Washington, Oregon, Utah and Idaho.
UWH partners with long-term care facilities, including skilled nursing facilities, assisted living facilities, and adult family homes, to provide wound care to patients residing in those facilities. UWH providers travel to the partner facilities, where they conduct rounds to identify and treat patients with wounds, including wounds caused by pressure, dermatitis, vascular disease, diabetes, and surgery.
Between 2015 and 2022 UWH allegedly submitted false claims to the Medicare and Medicaid programs for evaluation and management (E&M) services. Medicare generally prohibits healthcare providers from separately billing for E&M services provided on the same day as another medical procedure, unless the E&M services are significant, separately identifiable, and above and beyond the usual pre- and post-operative care associated with the medical procedure.
The settlement resolves allegations in a lawsuit filed in the Western District of Washington by Dena Walker, a former employee of UWH. The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery Ms. Walker will receive approximately $58,426 as part of the resolution.
“Providers have a responsibility to submit accurate claims to Medicare and Medicaid that are driven by patient needs,” said Steven J. Ryan, Special Agent in Charge at the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “As this case demonstrates, HHS-OIG is committed to investigating those who threaten the integrity of federal health care programs and recovering valuable taxpayer dollars so they can be used for their intended purposes.”
Of the settlement amount, $273,711 will go to the federal government and $18,420 will go to the state of Washington. Of those amounts, $130,136 is restitution to federal healthcare programs, and $15,929 is restitution to the state. The False Claims Act allows for increased damages to discourage improper billing to federal programs.
The matter was investigated by the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).
This resolution was negotiated by Assistant United States Attorney Ashley Burns. Senior Counsel Carrie L. Bashaw handled the matter for the Washington State Attorney General’s Office.
Outcome: Settled for $273,711.