Billed separately for evaluation and management services that were included in reimbursement for wound care procedures
Seattle – The U.S. Department of Justice, the Washington State Attorney General’s Medicaid Fraud Control Division, and United Wound Healing P.S., today resolved allegations that United Wound Healing (UWH) of Puyallup, Washington, had improperly billed Medicare and Medicaid for services provided in nursing homes and care facilities in Washington, Oregon, Utah, and Idaho. UWH will pay $292,132 to resolve the matter. The company is settling the matter but admits no wrongdoing.
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...
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