SEATTLE – The U.S. Department of Justice, the Washington State Attorney General’s Medicaid Fraud Division, and United Wound Healing PS today announced that United Wound Healing (UWH) in Puyallup, Wash., was awarded Medicare and Medicaid for services provided in nursing. We have resolved the claim that you were improperly billed. Housing and nursing homes in Washington, Oregon, Utah and Idaho. UWH will pay him $292,132 to fix this issue. The company has resolved the issue, but has not admitted any wrongdoing.
UWH partners with long-term care facilities such as skilled nursing facilities, nursing homes and adult family homes to provide wound care to patients living in these facilities. UWH providers travel to partner facilities to conduct rounds to identify and treat patients with wounds, including wounds caused by compression, dermatitis, vascular disease, diabetes, and surgery.
From 2015 to 2022, UWH allegedly submitted false claims to Medicare and Medicaid programs for evaluation and management (E&M) services. Medicare generally requires that the E&M service be critical, separately identifiable, and provided by a provider the same as another medical procedure, except where it exceeds the usual pre- and post-operative care associated with the medical procedure. Separate billing for E&M services provided on a daily basis is prohibited.
The settlement resolves claims filed in the Western District of Washington by former UWH employee Dena Walker. The lawsuit Kitam, or whistleblowers, provisions of the False Claims Act. This permits individuals to sue and share collections on behalf of the government for false claims. Mr. Walker will receive approximately $58,426 as part of the settlement.
“Providers are responsible for submitting accurate claims to Medicare and Medicaid based on patient needs,” said Steven J. Ryan, Special Officer, Office of the Inspector General, Department of Health and Human Services (HHS-OIG). says. “As this case illustrates, HHS-OIG is committed to investigating those who threaten the integrity of the federal health care program and recovering valuable taxpayer funds so that they can be used for their intended purposes. I have.”
Of the settlement amount, $273,711 will go to the federal government and $18,420 will go to the state of Washington. Of these amounts, $130,136 is returned to federal health programs and $15,929 is returned to states. The False Claims Act allows increased damages to discourage improper claims against federal programs.
This issue was investigated by the US Department of Health and Human Services Office of the Inspector General (HHS-OIG).
The resolution was negotiated by U.S. Assistant Attorney Ashley Burns. Senior Attorney Carrie L. Bashaw handled this matter for the Washington State Attorney General’s Office.