Bitter Pills

Side effects in the UW billing scandal.

THE MEDICARE BILLING battle at the University of Washington is still taking casualties. Almost half the faculty in one division is now threatening to resign unless the medical school appoints a new head of nephrology who is an outsider, untainted by the ongoing federal investigation into as much as $10 million in questionable billings in the past decade. Additionally, some disgruntled UW doctors, disappointed by the school's overall response to the scandal, are challenging the university's claim that the Medicare and Medicaid billings in question were the result of disagreements over bureaucratic regulations. Doctors say some faculty members were actually schooled on how to beat the government out of insurance money.

In one example, two doctors, who requested anonymity, say they were part of a small gathering of UW physicians in the late 1990s who were told how to "creatively" bill the government for reimbursements. The doctors say that when another doctor stood and questioned such procedures, saying it sounded like Medicare fraud, the ranking doctor leading the session responded: "How will I get caught?"

Federal prosecutors were subsequently told of the strategy meeting as part of their four-year probe, and the doctor is now under suspicion of fraud. UW Medicine spokesperson L.G. Blanchard said last week that the school was unaware of such allegations, and federal prosecutors won't comment. Prosecutors have said UW doctors billed for medical procedures that weren't performed and charged for services by doctors who weren't in attendance at the time.

The Justice Department has already obtained the criminal conviction of one UW physician and is expected to possibly charge at least two others. In a November plea bargain, brain surgeon H. Richard Winn pleaded guilty to obstructing the investigation. He resigned his department chair and had to repay the government $500,000 in "incorrect claims" (see "Brain Damage," Jan. 15).

The UW itself faces millions in potential civil fines or settlements. The school has now run up $25 million in legal fees, which is coming out of the UW doctors' salary pool, over their objections. However, in the nephrology division at the Fred Hutchinson Cancer Research Center, where UW staff doctors treat and study kidney diseases, the dispute is over the school of medicine getting its house in order, insiders say. Protesting doctors—eight out of a staff of 18—are mad enough to resign, they say. Seven of the eight protesters are senior faculty members. They recently endorsed a letter opposing the likely appointment of Dr. Stuart Shankland, a UW doctor, to replace division head William Couser, who, the UW has confirmed, is negotiating a possible federal plea deal for alleged billing irregularities.

Couser, who stepped down last year but remains on the faculty, is backing Shankland and fired off a widely distributed response to the protesters, calling some of them "previously outstanding citizens of the division, bent on . . . a destructive personal vendetta." (Couser's attorney, Jim Lobsenz, says the doctor has no further comment.) Faculty member Suhail Ahmad wrote back, saying he hoped fellow doctors wouldn't be "intimidated, labeled destructive, or [be] in fear of any reprisals or persecution" due to Couser's letter.

Protesters are not questioning Shankland's ability but want an outsider who has no ties to Couser or the scandal, they say. Shankland is considered a Couser prot駩. A UW provost last week told a delegation of doctors that the final decision on the appointment belongs to Department of Medicine chair Dr. William Bremner. Bremner did not respond to phone and e-mail requests for comment. But in a Dec. 31 letter, he insisted a "full national search" was completed, resulting in a search committee's recommendation of three finalists. Shankland won the committee's final nod over two outsiders. "I concur with the recommendation," Bremner wrote, "and am entering into negotiations with Dr. Shankland."

Says one angry Hutch doctor: "We simply want the division to make a clean break from the scandal. But this fight is becoming a scandal in itself."

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