UWMC under fire from the feds

The UWMC is currently under investigation by federal authorities on allegations of fraud. Within the past five years, as the federal government has cracked down on Medicare and Medicaid fraud, the UWMC stands as the first hospital in the nation that runs a medical school to be charged criminally by any federal agency.

The Federal Bureau of Investigation, the Department of Health and Human Services, and the U.S. Attorney General's Office may indict four doctors and two administrators for allegations of Medicaid and Medicare fraud. UW Physicians and Children's University Medical Group are groups currently being investigated. Both practices provide services at UWMC, Harborview Medical Center, Children's Hospital and eight regional clinics.

Federal agents conducted a raid on UW Physicians in November of 1999, after tips from a former employee led agents to believe doctors were over billing for Medicaid and Medicare services -- federally subsidized programs that offers health care for the elderly and the financially destitute. According to The Seattle Times, both practices received a total $35.8 million from the two programs during the fiscal year ending in June of 2000.

Allegations include doctors billing for procedures while they were on vacation, falsely claiming they were present when residents were performing certain procedures and false claims of more expensive procedures used in place of cheaper ones. These allegations have been heard by a grand jury. Most billing fraud cases are settled with civil payments.

Mark Erickson, who worked for both UW Physicians and Children's University Medical Group from 1991-9, filed suit under the federal False Claims Act, a law that allows those who report instances of fraud against the government to receive about 15 to 20 percent of what is recovered. According to The Times, the case was built on tapes that Erickson recorded secretly over a three-month period while working for one of the practices. Erickson could not be reached for comment.

"We have concluded that some of our procedures and compliance efforts have fallen short, and we are making a number of improvements," said Dr. Paul G. Ramsey, vice president for medical affairs and dean of the School of Medicine in a prepared statement.

"Those who seek reimbursement under the existing, complex guidelines face the very real risks of honest mistakes being cast by prosecutors as an intentional act of criminal fraud," said Ramsey in his statement.

According to Ramsey, billing for health-care services "is among the most confusing, burdensome, ever-changing and expensive areas of federal regulation today."

Dan Dubitzky, a criminal-defense lawyer hired by the medical center, claims that he has not found any billing of a fraudulent nature, but that bookkeepers have instead made errors.

"We know of no instance in which criminal charges have been filed for billing improprieties in these settings; we should be treated no differently," said Ramsey in his statement.