Robin Laananen
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To some, Dr. H. Richard Winn was the University of Washington's fall guy. If so, it was a soft landing. Investigated for submitting hundreds of thousands of dollars in questionable Medicare and Medicaid insurance billings, the 60-year-old UW brain surgeon plea-bargained a lesser charge of obstruction of justice and, in November, was sentenced to five years of probation and 1,000 hours of community service—in the community of Katmandu. With court approval, he's spending four months teaching and treating patients at Tribhuvan University Teaching Hospital in Nepal, where the neurology department is just seven years old. Winn also lost his prestigious UW chair in neurosurgery, paid a $4,000 criminal fine, and had to pay $500,000 to Medicare and Medicaid. On the other hand, that half-million was money prosecutors say he wrongly appropriated from taxpayers in the first place, submitting "incorrect claims" throughout the 1990s. For agreeing to resign, he also received a golden parachute of $970,000 and was excused by the UW from paying $500,000 in legal fees. "Anyone who thinks the punishment called for here is too lenient has no idea what Dr. Winn and his family have been through in the last year and what still lies ahead of them," insisted U.S. District Court Judge Robert Lasnik at sentencing, adhering to U.S. Attorney John McKay's leniency recommendations. But what lies ahead for Winn—he has already dashed off a check for the $504,000—is no prison time and no likely loss of his medical license. He also remains eligible to receive federal grants, can still bill for Medicare work, can obtain another prestigious teaching position elsewhere, and has a guarantee of up to $3.7 million in UW unemployment compensation until he finds the job he wants. Let that be a lesson to him.
More pressing now is what lies ahead for the UW and its medical school. The complex federal probe—which began in 1999, the year the UW settled an earlier Medicare-billing dispute by paying back $3.6 million—hangs over the campus like the methane that lingers over the old Montlake dump. Winn's actions and conviction foreshadow an uproar to come if, as some UW and federal officials are predicting, the university ends up paying as much as $25 million in legal fees, fines, and settlement paybacks resulting from a decade of questionable Medicare billings. Cautions L.G. Blanchard, spokesperson for UW Medical, the umbrella name for the med school and UW hospitals and medical clinics: "No one knows exactly how much money is in dispute; it could be $1 million, it could be a lot more." The questioned billings from the 1990s have been ballparked at $10 million to $20 million—some or all of which the school could be asked to repay through a negotiated settlement, and which could constitute one of the nation's largest university Medicare-billings cases. The UW insists its actions weren't intentional and notes that some hospitals and doctors around the U.S. have stopped accepting Medicare patients because of such billing disputes and unfair reimbursements. Figures for fiscal 2002 show just how much the university and the government typically disagree on what services are covered and what aren't: The UW billed Medicare and Medicaid for $107 million but was paid only $34 million. The $73 million difference, says Blanchard, "was just money out the door" for the university.
'PISSED OFF ABOUT WINN'
The UW's legal fees and any fines or settlements will be taken in part from the earnings of other doctors, some of whom are mulling legal action to recover lost income. By law, the UW's Medicare and Medicaid funding also could be cut, though that's highly unlikely. Additionally, U.S. prosecutors are on the verge of filing one or two more criminal complaints against UW doctors. "I can't say much," says assistant U.S. attorney Susan Loitz, who helped prosecute Winn, "because it's an ongoing criminal investigation." The UW last week said kidney doctor and chief of nephrology William Couser, 63, was discussing a plea deal. Like Winn, he is suspected of illegally billing thousands of dollars in Medicare services.
At the UW, you can cut the tension with a scalpel. "I swear," says one veteran physician, "everyone out here's got an attorney or is retyping their r鳵m鳮" The UW concedes that "hundreds" of UW employees have been provided "dozens" of attorneys during the four-year federal probe. Some of the questioned Medicare billings date back to 1992 and have been the product of untold numbers of doctors and billing personnel. An operating-room nurse says doctors' voices rise when they begin talking about the costs and the harm done by the scandal, especially when Winn's name pops up. "Oh god, are they pissed off about Winn and his deal," says the nurse, who describes the doctors' angst as a "firestorm brewing."
Such anger is misdirected, says spokesperson Blanchard. Winn's $500,000 legal costs indeed came out of the doctors' revenue pool, he confirms. But money for Winn's multimillion-dollar resignation pact comes from other "nonpublic" revenue. (The UW considers revenue other than state dollars as nonpublic, though the state, of course, owns and operates the tax-exempt school.) The thing is, says Blanchard, "This place continues to function extremely well," and, he emphatically notes, only one out of 1,300 staff doctors has been indicted. "Some people are mad," Blanchard says. "We understand that. But as an overall enterprise, we continue to function as usual and attract top-notch faculty" such as newly hired genome researcher Robert Waterson, who, Blanchard says, "knew all about the investigation." Not a single faculty member has quit Winn's former neurology department because of the scandal, Blanchard adds. But the school also acknowledges that Department of Medicine chair William Bremner is playing referee in a squabble over a replacement for chief of nephrology Couser; some doctors want an outsider, but, says Blanchard, a selection committee has opted for an in-house candidate, Stuart Shankland. The UW says it's not a major dispute, although Bremner, in a recent e-mail, asked doctors "to put aside feelings of divisiveness that have been increased by the profound stresses of the investigation."
