reached a $22.7 million settlement to resolve healthcare fraud allegations that it falsely billed Medicare and Medicaid for medically unnecessary neurosurgery procedures.
The settlement between Providence, the US Department of Justice (DOJ), and the state of Washington marks the largest healthcare fraud settlement in the Eastern District of Washington.
Providence operates 51 hospitals in seven states, including Providence St. Mary’s Medical Center in Walla Walla, Washington. The settlement centers around two neurosurgeons employed at Providence St. Mary’s between 2013 and 2018, identified as Dr. A and Dr. B in the case.
The health system paid neurosurgeons based on a productivity metric that incentivized them to perform more complex surgical procedures. Providence paid Dr. A between $2.5 million and $2.9 million a year from 2014 to 2017 based on this productivity metric, according to the case.
The settlement resolves allegations that Providence billed Medicare, Washington State Medicaid, and other federal healthcare programs for medically unnecessary neurosurgery procedures that Dr. A and Dr. B performed.
The health system admitted that Providence St. Mary’s medical personnel had expressed concerns about the doctors. Personnel stated that the doctors were endangering the safety of patients, creating an excessive level of complications and adverse outcomes through their surgeries, performing surgeries on candidates who were not appropriate for surgery,...
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