OLYMPIA, Wash. (Legal Newsline) - Washington Attorney General Bob Ferguson announced a $259,649 agreement on Wednesday with a Tacoma-based physician group to resolve allegations it knowingly overbilled the state's Medicaid program.
Sound Inpatient Physicians employs hospitalists and other physicians who provide care to patients at medical facilities. Hospitalists are physicians who provide in-patient care to hospital and other facility patients. Between 2004 and 2012, Sound allegedly submitted inflated claims for higher and more expensive levels of service than were documented in patient medical records by the hospitalists.
"Providers who participate in our state's Medicaid program must accurately bill for services provided and accurately document those services in the patient record," Ferguson said. "If you participate in the Medicaid program, you must play by the rules."
Sound reached an agreement with the federal government in 2013, requiring the physician group to participate in an annual audit by an independent contractor for five years to ensure overbilling does not occur.
Under the terms of the agreement on Wednesday, Washington is requiring Sound to include review of Washington claims in the annual audit. Sound admitted no liability or wrongdoing as part of the agreement.
Ferguson's Medicaid Fraud Control Unit (MFCU) prosecutes healthcare provider fraud committed against the state's Medicaid program. In 2013, the MFCU reclaimed more than $27 million from healthcare providers and drug companies.