Providence Health & Services agreed to pay $22.7 million to settle allegations that two of its neurosurgeons falsely billed federal healthcare programs for medically unnecessary spine surgeries, in the largest-ever healthcare fraud settlement in the Eastern District of Washington, according to the Department of Justice (DOJ).
The health system, the U.S. federal government, and the state of Washington reached a joint settlement Tuesday following a whistleblower complaint, which alleged that two spine surgeons employed at Providence St. Mary's Medical Center in Walla Walla provided poor care and committed billing fraud from 2013 to 2018.
Providence, a large health system that has 51 hospitals in seven states, paid neurosurgeons based on a productivity metric, which gave them a financial incentive to perform more surgeries of greater complexity, the DOJ alleged. From 2014 to 2017, one of the surgeons in question earned between $2.5 and $2.9 million a year based on this metric, according to the settlement agreement.
The health system admitted that during the time period that the spine surgeons were employed, other medical staff expressed concerns that they endangered patients, performed surgeries that resulted in complications, conducted surgeries on patients when they were not appropriate, and did not adequately document their procedures.
Providence also acknowledged that while it did eventually place both of these surgeons on administrative leave, it allowed both...
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