• 'The numbers don't lie': Endoscopy to become more prominent among next generation of spine surgeons
  • Minnesota orthopedic group hit with $111M negligence verdict
  • Orthopedic patient's death highlights potential dangers of prior authorization
  • Spine surgeon killed in Oklahoma hospital shooting
  • Neurosurgeon accepted $3.3M in illegal payments to perform spine surgeries at hospital
  • Spine surgeon gets jail time for abusing patient during hospital visit
  • Providence to pay $22.7M to settle unnecessary spine surgery allegations
  • Texas spine surgeon defending himself from 'Dr. Death 2.0' allegations
  • 'They're on really thin ice': Why 1 insurer has drawn spine surgeons' ire
  • Orthopedic surgeon must face suit in patient's death
  • Spine surgeon 1 of 9 physician billionaires on Forbes' 2022 list
  • Connecticut hospital to appeal $12.5M verdict to family of patient who died after orthopedic surgery
  • 4 spine technologies that promised more than they delivered
  • Orthopedic surgeon's health system exit steeped in controversy
  • Terminated orthopedic surgeon contracts with another New York hospital
  • Texas spine surgeon sued by State Farm over 'unnecessary' procedures
  • 22 hospitals ranked top 25 orthopedic hospitals 3+ years in a row
  • Orthopedic surgeon convicted of battery at hospital
  • UArizona neurosurgery chair dies after motorcycle collision
  • America's largest independent practices by number of spine surgeons
  • Could Medtronic's spine business be the next medtech spinoff?
  • 41 'rising stars' in orthopedics
  • Idaho orthopedic surgeon arrested for alleged misconduct at practice
  • Neurosurgeon's startup hits $1.2B valuation
  • Orthopedic surgeon indicted in $10M telemedicine fraud scheme
  • Orthopedic surgeon salaries in the 5 best, worst states for healthcare
  • New Jersey hospital must pay neurosurgeons $24.3M, appeals court rules
  • Good news, bad news for orthopedic surgeons: 6 observations
  • Why private equity is bettering orthopedics, 3 physician leaders say
  • Florida hospital patients say they were injured during surgeries. Now a physician faces 350 lawsuits.
  • Texas spine surgeon's $11M verdict being appealed
  • A Rutgers physician accused of 'ghost surgeries' will return — but with fewer responsibilities
  • Top orthopedic hospital in every state: US News
  • Rothman Orthopaedics to become national brand, but no 'aspirations to go beyond US'
  • Sports medicine physician fired amid misconduct allegations involving patients
  • Orthopedic surgeon asking for misconduct charges to be dropped
  • Unnecessary spine cases spur class action lawsuit
  • Colorado Supreme Court rejects hospital's bid to enforce $229K spine surgery bill
  • Jury finds neurosurgeon largely responsible for paralysis, awards $15.5M in damages
  • Dr. Jon Yoon performs NHL's 4th disc replacement in 7 months
  • 'The numbers don't lie': Endoscopy to become more prominent among next generation of spine surgeons
  • Neurosurgeon accepted $3.3M in illegal payments to perform spine surgeries at hospital
  • Carson Daly has 2nd spine procedure in 3 months
  • Spine surgeon steps down as CEO of biologics company
  • 2 professional athletes undergo spine surgery in a week
  • Providence to pay $22.7M to settle unnecessary spine surgery allegations

    Providence to pay $22.7M to settle unnecessary spine surgery allegations

    Alan Condon -  

    Renton-based Providence Health & Services Washington has agreed to pay $22.7 million to resolve allegations that it defrauded federal healthcare programs with medically unnecessary neurosurgery procedures.

    Between 2013 and 2018, Providence St. Mary's in Walla Walla, Wash., employed two neurosurgeons identified as Dr. A and Dr. B in the settlement agreement. The hospital paid the surgeons based on a productivity metric that provided them a financial incentive to perform more complex surgeries, the Justice Department said in an April 12 news release.  

    Dr. A was among the highest-producing neurosurgeons across Providence, which operates 51 hospitals in seven states. Over a four-year period, Providence paid Dr. A between $2.5 million and $2.9 million a year based on the productivity metric, according to prosecutors.

    Providence admitted medical staff raised concerns about the practices of Dr. A and Dr. B while they were employed at Providence St. Mary's. Prosecutors said those concerns included endangering the safety of patients; creating an excessive level of complications and negative outcomes; performing surgery on candidates who were not appropriate for surgery; and improperly documenting their procedures and outcomes.

    The health system also admitted Dr. A exaggerated diagnoses to get reimbursement from insurers; performed surgeries that did not meet the requirements set by Medicare and other insurance programs; performed surgeries of greater complexity and scope than were medically appropriate; and jeopardized patient safety by performing an excessive number of complex cases.

    Although Dr. A and Dr. B were placed on administrative leave in February 2017 and May 2018, respectively, they were allowed to resign while on leave and Providence did not report the surgeons to the National Practitioner Data Bank or the Washington State Department of Health, according to prosecutors.

    The Justice Department learned about the allegations when a whistleblower — later identified as Providence St. Mary's former neurosurgery director — filed a False Claims Act complaint against the health system in January 2020. The whistleblower will receive $4.2 million of the settlement amount.

    "Providence's failure to ensure that Dr. A and Dr. B were performing safe and medically appropriate surgery procedures, despite repeated warnings, put patients' lives and safety at serious risk," said Vanessa Waldref, the U.S. attorney for the Eastern District of Washington. "I am also gravely concerned that Providence's decision not to report Dr. A or Dr. B to federal or state medical oversight bodies allowed both surgeons to simply resign from Providence and then continue to endanger patients at other hospitals."

    The system has entered into a corporate integrity agreement with HHS that requires it to implement and maintain several quality and patient safety obligations. The agreement also requires that Providence retain outside experts to perform annual claims and clinical quality systems reviews.

    "We are committed to taking specific, concrete actions to ensure this isolated incident in Walla Walla does not happen again," Providence said in a statement emailed to Becker's. "Although the events in question occurred at one Providence hospital in the southeast region of Washington State, we initiated a broad and comprehensive internal review of our policies, practices and procedures to ensure robust compliance with government requirements and the delivery of high-quality care."

    Copyright © 2022 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

    Featured Webinars

    Featured Podcast

    Featured Whitepapers