Sound Inpatient Physicians to make payment to state’s Medicaid Program
OLYMPIA—In response to allegations that it knowingly overbilled the state over an eight-year period, a Tacoma-based physician group will pay $259,649 to the state’s Medicaid program.
“Providers who participate in our state’s Medicaid program must accurately bill for services provided and accurately document those services in the patient record,” said Attorney General Bob Ferguson “If you participate in the Medicaid program, you must play by the rules.”
Sound Inpatient Physicians employs hospitalists and other physicians who provide care to patients at hospitals and other facilities. Hospitalists are physicians who provide in-patient care to hospital and other facility patients. Sound contracts with hospitals and other facilities to provide these services.
The Attorney General’s Medicaid Fraud Control Unit (MFCU) alleged that, between 2004 and 2012, Sound knowingly submitted inflated claims for higher and more expensive levels of service than were documented by the hospitalists in patient medical records.
Sound faced similar allegations made by the federal government and a whistleblower in 2013. As part of its agreement with the federal government, Sound was required to participate in an annual audit by an independent contractor for five years to ensure that the overbilling does not occur in the future. As part of the agreement announced today, Washington is requiring Sound to include review of Washington claims in that annual audit as well.
The claims resolved in this case are allegations only. There has been no legal determination that Sound engaged in fraudulent conduct.
The MFCU worked with the Washington State Health Care Authority to bring this case under Washington’s Medicaid False Claims Act, which was enacted by the Legislature in 2012. Senior Counsel Carrie L. Bashaw was the lead on this case.
Washington’s Medicaid Fraud Control Unit
The Attorney General's MFCU is responsible for the investigation and prosecution of healthcare provider fraud committed against the state’s Medicaid program.
In addition, the unit coordinates the investigation and prosecution of abuse and neglect involving vulnerable adults residing in Medicaid-funded residential facilities with local law enforcement authorities through a statewide network.
In 2013, Washington’s MFCU reclaimed more than $27 million from drug companies and healthcare providers.
Report suspected Medicaid fraud: 1-800-562-6906 or send an email to HotTips@hca.wa.gov.
You can also report provider fraud via the Attorney General’s Office website.
The Washington Department of Social and Health Services, Office of Fraud & Accountability investigates client fraud. You can report Medicaid Client Fraud via the Department’s Online Complaint Form, call the Welfare Fraud Hotline at 1-800-562-6906 or send the complaint to Welfare Fraud Hotline, P.O. Box 45817, Olympia, Washington 98504-5817.
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The Office of the Attorney General is the chief legal office for the state of Washington with attorneys and staff in 27 divisions across the state providing legal services to roughly 200 state agencies, boards and commissions. Attorney General Bob Ferguson is working hard to protect consumers and seniors against fraud, keep our communities safe, protect our environment and stand up for our veterans. Visit www.atg.wa.gov to learn more.
• Janelle Guthrie, Director of Communications, (360) 586-0725
• Alison Dempsey-Hall, Deputy Communications Director, (206) 641-1335