Gov’t, United Wound Healing settle allegations

SEATTLE, Wash. – The U.S. Department of Justice, the Washington State Attorney General’s Medicaid Fraud Control Division, and United Wound Healing P.S. have resolved allegations that Puyallup, Wash.-based UWH 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, but the company admits no wrongdoing. “Providers have a responsibility to submit accurate claims to Medicare and Medicaid that are driven by patient needs,” said Steven Ryan, special agent in charge at the U.S. Department of Health and Human Services, Office of Inspector General. “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.” 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 health care 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. Walker will receive approximately $58,426 as part of the resolution.