Washington Healthcare Fraud/Medicare Fraud Enforcement

Contact Form - Your First Step

In Washington, major healthcare fraud is civilly and criminally prosecuted by the Eastern and Western United States Attorney’s Offices and the State’s own Medicaid Fraud Control Unit.

The federal government often accomplishes this task with the assistance of the Washington Medicaid Fraud Control Unit (MFCU). The MFCU takes the responsibility of stopping fraud very seriously and is often assisted in its efforts by the bravery and actions of whistleblowers.

Modeled after the federal False Claims Act, the Washington False Claims Act permits private citizens to bring qui tam actions on behalf of the State of Washington to recover treble damages and civil penalties. Wash. Rev. Code Ann. §§ 48.80.010 – 48.80.900.

Nolan Auerbach & White represents whistleblowers in federal court only. We will bring cases on behalf of whistleblowers under the Washington qui tam statute as part of an action under the federal False Claims Act. We do so under the Court’s pendent jurisdiction.

The liability provisions of the Washington False Claims Act, Wash. Rev. Code Ann.  § 48.80.030, provide liability for any person who:

1.         makes or presents or causes to be made or presented to a health care payer a claim for a health care payment knowing the claim to be false;

2.         knowingly presents to a health care payer a claim for a health care payment that falsely represents that the goods or services were medically necessary in accordance with professionally accepted standards;

3.         knowingly makes a false statement or false representation of a material fact to a health care payer for use in determining rights to a health care payment.

 

Cases completed in Washington that were originally brought in a Washington federal court include:

In April 2004, the DOJ announced that the University of Washington Physicians, Children’s University Medical Group, and Association of University Physicians had agreed to pay $35 million to settle allegations of Medicare fraud. The Government alleged that University of Washington Medical system doctors falsely claimed to have been present at tests that were actually conducted by residents. Then, the doctors destroyed evidence of the fraud and rewrote audit reports to receive increased Medicare funding.

 

Cell Therapeutics, a pharmaceutical company based in Seattle, agreed to pay $10.5 million to settle allegations that it paid illegal kickbacks to physicians in violation of the Anti-Kickback Statue and the False Claims Act. Relator James Marchese, a former oncology account manager with Cell Therapeutics Inc, filed a qui tam complaint in 2006 against his former company, alleging that CTI had improperly marketed its cancer drug, Trisenox, for unapproved uses through an unlawful kickback scheme. To induce doctors to prescribe its drug to potential patients, CTI provided them with substantial monetary payments as well as other incentives such as free food, entertainment, and travel. Additionally, CTI knowingly made false statements to the physicians by telling them that Trisenox was approved for certain off-label uses. The result of this kickback scheme was the payment of millions of Medicare/Medicaid dollars for the medically unproven use of a drug.