Providence Health agrees to pay DOJ $22M to settle allegations over unnecessary surgeries

Providence Health will pay the federal government $22 million to settle allegations that it billed government programs for unnecessary spinal surgeries. 

The Justice Department announced on Tuesday that the 52-hospital system entered the settlement over allegations it falsely billed Medicare, Medicaid and other federal government programs for unnecessary procedures performed by two unnamed doctors.

“Providence’s failure to ensure Dr. A and Dr. B were performing medically appropriate surgery procedures, despite repeated warnings, put patients’ lives and safety at serious risk,” said U.S. Attorney Vanessa Waldref in a statement on Tuesday. 

Providence admitted that while the two doctors were employed at the hospital chain medical personnel warned the system that the practitioners were endangering patients but performing surgeries on people who were not appropriate for that procedure, the Justice Department said in a release. 

Another concern was that the doctors failed to document proper outcomes and procedures and performed procedures that didn’t “meet the medical necessity requirements set by Medicare and other insurance programs,” the release said. 

The doctors also performed too many overly complex surgeries and in doing so jeopardized patient safety, DOJ said.

Providence placed both doctors on administrative leave in Feb. 2017 and March 2018 and allowed them to resign.

The case started in January 2020 from a whistleblower complaint from the former director of neurosurgery at Providence Health.

Providence said in a statement that the events took place in one Providence hospital in Walla Walla, Wash.

The system added that it “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.”

Providence added that it has strong existing protocols in place, but it is “committed to taking specific, concrete actions to ensure this isolated incident in Walla Walla does not happen again.”