By Dr. Janet Parker
In the University of Washington Medicare-fraud case a medical whistleblower alleged that clerks were ordered to forge doctor signatures and re-create old records. As in many other cases of medical fraud, pressure from authorities and fear of loosing their employment, kept employees at the Harborview Medical Center's University of Washington facility quiet.
There has been well-publicized four and one - half year Federal billing investigation of University of Washington School of Medicine that has resulted in criminal felony convictions of two nationally prominent physicians, a $35 million settlement and the expenditure of $27 million for legal and other costs. Two prominent faculty members, Dr. Richard Winn, Chair of the Department of Neurological Surgery and Dr. William Couser of the Nephrology Division, pled guilty to criminal charges (obstruction of justice and fraud).
The Federal government arrived at a figure of approximately $70 million in over billings to Medicaid and Medicare. Given the treble damages allowed, the government’s total figure was approximately $210 million. The government’s investigation concentrated on the Department of Neurological Surgery, the Division of Nephrology and the Interventional Radiology Section. Although only two doctors pled guilty, there was broad systemic problems at UW involving no less than three dozen physicians from at least eight departments and no less than seven administrators who could easily have found themselves facing criminal charges.
The ability of criminals in the medical community to keep Medical Fraud and the Money Laundering that accompanies it, from the scrutiny of Law Enforcement. I like to call this the White Coat Barricade. It is similar in its effects to the Blue Line - which is so common in the investigation of law enforcement officers by other officers. No one wants to "rat out" a friend or co-worker. But just like those few corrupt law enforcement officers in the ranks, a medical doctor who is doing medical fraud and money laundering is dangerous to his co-workers. Law Enforcement Officers know their safety is crucially dependent on those officers they work with. The safety of patients, the public and co-workers in the medical field is also dependent on the medical staff they work with. Medical Doctors handle dangerous materials - infectious agents, radioactive waste, hazardous chemicals, and anesthesia.
During the course of the case University of Washington (UW) Medicine provided the government with over 563,000 pages of documents. In total, approximately 175 Federal subpoenas were issued to UW Medicine’s hospitals, related entities and the Practice Plans. There were over 200 individuals who were interviewed by the government investigators. Medical Whistleblowers brought evidence of massive illegal billings that have occurred within the kidney dialysis area, including billings for physicians’ services at times when they were documented to be on vacation. In addition nephrology charts were being returned to physicians for documentation up to one year after the procedure. When explicit allegations of fraud were raised, response of the UW administration was clearly inadequate and a broader and more thorough investigation of the problems should have been done at the time.
But it must be remembered that problems of this scope, are seldom due solely to a small number of “bad actors.” It is necessary to examine the broad cultural and systemic causes that permitted the fraud to occur.
This case clearly represents the need for increased awareness and responsiveness to Medical Whistleblowers. The current culture of the Medical Community is not conducive to those who wish to report fraud and abuse. Historically in many cases medical whistleblowers faced severe retaliation as a result of coming forward. The use of Bad Faith Peer Review and Administrative Sanctions to silence medical whistleblowers should be more fully investigated by those in law enforcement and governmental regulatory agencies.
This work is licensed under the Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0/ or send a letter to Creative Commons, 171 Second Street, Suite 300, San Francisco, California, 94105, USA.