Seattle Pain Center providers routinely charged Medicaid for unnecessary urine tests
OLYMPIA — Attorney General Bob Ferguson today announced that Seattle Pain Center, a shuttered network of eight pain clinics formerly owned by Dr. Frank Li, will pay $1.1 million to Washington’s Medicaid program.
The recovery is a result of an investigation into the clinics’ unnecessary urine tests co-lead by the Attorney General’s Office, the U.S. Attorney’s Office for the Western District of Washington and the Office of the Inspector General. The investigation found that Li billed Medicaid for urine tests that patients often did not need and sent the tests to his own lab, which, from 2013 to 2014, was not licensed to perform these types of tests.
While investigating the urine tests, the Attorney General’s Office Medicaid Fraud Control Division uncovered Li’s excessive opioid prescriptions and reported him to the state Medical Quality Assurance Commission (MQAC), which suspended Li’s license in 2016. Between 2007 and 2016, Li alone wrote nearly 3,000 OxyContin prescriptions. From 2010 until Li’s license suspension, at least 60 Seattle Pain Center patients died, many of opioid-related causes.
“Our investigation helped stop Dr. Li and the providers he supervised from continuing to prescribe dangerous and excessive amounts of opioids,” Ferguson said. “Now we’re reclaiming more than one million Medicaid dollars for the unnecessary drug tests he ordered for his opioid prescription practice. These recouped dollars will cover medical costs for vulnerable Washingtonians, as it was intended.”
“Prescribing massive quantities of addictive opioids fed a crisis that continues to grip our community,” said First Assistant U.S. Attorney Tessa M. Gorman. “This billing for unnecessary urine tests is a way Dr. Li and his clinics profited on the pain of others. It is appropriate that we return these dollars to the government entities that were defrauded.”
From July 2013 to February 2015, Seattle Pain Center routinely and excessively ordered unnecessary urine drug tests for patients. The urine samples were tested at Northwest Analytics, a lab that Li owned exclusively. In addition, Northwest Analytics was not licensed or accredited to perform urine drug tests from 2013 to 2014.
In 2015, the Washington State Health Care Authority suspended Medicaid payments to Seattle Pain Center after the Attorney General’s Office began its investigation into Li’s urine testing practices.
Li’s policy encouraged Seattle Pain Center providers to order drug tests during every patient visit, even though he knew that Medicaid only covers tests that are medically necessary and based on a patient’s medical condition.
Medicaid requires providers to individually assess and document the need for each test for each patient. Seattle Pain Center billed Medicaid for urine drug tests on most of their patients, even when those tests were not medically necessary. Many patients, including those with chronic pain and receiving opioids, do not need extensive urine drug tests every time they see a provider. Seattle Pain Center providers ordered tests for drugs they already knew their patients were or were not taking — including drugs their patients were prescribed.
Senior Counsel Carrie Bashaw is leading the case for the Attorney General’s Office Medicaid Fraud Control Division.
While investigating the excessive urine drug testing, the Attorney General’s Office Medicaid Fraud Control Division became concerned about Seattle Pain Center’ excessive opioid prescriptions. Between 2007 and 2016, Li alone wrote nearly 3,000 OxyContin prescriptions.
The Attorney General’s Office reported Li to the state Medical Quality Assurance Commission (MQAC), which suspended Li’s license in 2016. From 2010 until Li’s license suspension, at least 60 Seattle Pain Center patients died, many of opioid-related causes.
Details about Li were included in the state’s lawsuit against Purdue Pharma, an opioid manufacturer. Purdue knew about Li’s excessive prescribing habits, but did not report him to the authorities.
The Office of the Attorney General is the chief legal office for the state of Washington with attorneys and staff in 27 divisions across the state providing legal services to roughly 200 state agencies, boards and commissions. Visit www.atg.wa.gov to learn more.
Brionna Aho, Communications Director, (360) 753-2727; Brionna.firstname.lastname@example.org