Federal investigators, in both the ongoing criminal and civil cases, have been studying the computerized and hand-written paperwork from two UW billing practices. One, UW Physicians, bills for the doctors' services to patients at UW Medical Center, UW Physicians Network, and at the UW's teaching hospital, county-owned Harborview Medical Center. (UW Physicians Network doctors provide care at a specialty center and eight community clinics from Auburn to Woodinville.) The second billing practice, Children's University Medical Group, serves school doctors working at Children's Hospital. Whistle-blower Erickson, 34, worked for both billing groups from 1991 to 2000. He claimed UW staff doctors charged the government for services they never performed. In some cases, doctors were billing for services while away on vacation, say federal officials. According to the charges in Winn's case, doctors also falsely filled out small treatment-billing cards they carry on their rounds.
'DISRUPTIVE AND DEMORALIZING'
Though millions of dollars are at stake, the scandal adds up to more than lost money. The revered Winn is gone. So is respected associate professor Arthur Fontaine, 55, the UW's former radiology-section chief. The UW says he was asked to step down during the investigation, and he has since left for a job at Group Health Cooperative. Couser, the kidney doctor now negotiating a plea, the UW says, also stepped down because of the investigation but remains at the school. UW Physicians administrator Brian McKenna and another medical-data official, Patrick Murphy, have become cooperating government witnesses, attorneys confirm.
Robin Laananen
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The university's Board of Regents, though it sought Winn's resignation, beseeched the court to accept his criminal plea bargain. Winn's leadership made UW neurology perhaps the top department of its kind in the U.S. Its doctors perform 3,000 operations a year, about 1,500 of them lifesaving, and six doctors who now chair other university neurology departments trained under Winn. He also enriched the school by leveraging a steady stream of research grants. (The UW is one of the top five U.S. grant schools and is first in such categories as biomedical research.) In a five-page letter penned by regents Dan Evans and Gerald Grinstein, the board claimed that rejection of Winn's plea could lead to an agonizing criminal trial (during which, of course, all the dirty details would have been aired) and would further distress medical-school personnel. "This process," the board said, "has been very disruptive and demoralizing for most people in the Department." If the court would accept Winn's deal, the medical school could "move on."
IT HAS MOVED ON, but to what? U.S. Attorney McKay said he hoped Winn's conviction would "reverberate" around the U.S., and some fear the UW will become an example as well. The Justice Department clearly wants university presidents everywhere to know that their campuses, too, could become a federal crime scene. "All of us neurosurgeons around the country and throughout the world understand that Dr. Winn has pleaded guilty and is thus accountable for his actions," says Dr. Mitchel Burger, a former UW neuro- surgeon who now is neurology chair at the University of California-San Francisco. He wrote the court supporting Winn's plea: "This will not be forgotten anytime soon, and has had a lasting impression on all of us in both the academic and private neurosurgical communities." The Seattle FBI office says health care fraud on all levels is the No. 2 white-collar crime in this region (bank fraud is first), and the agency has fielded a multi-jurisdictional task force to probe it locally. Federal officials say they're not focused on everyday billing errors but on patterns of them—like the UW's.
To tax-money watchdogs such as Bob Williams of the Evergreen Freedom Foundation in Olympia, "The UW is suffering from an ethics crisis." It's not just doctors like Winn, he says, but "the regents, trustees, and president who have taken no meaningful action to address the problem and restore the public trust." Problems with Medicare funding and bookkeeping are hardly new to the med school. Take 1997, a bountiful year. Medicare investigators determined the school was wrongly charging for experimental heart-implant devices. The UW eventually settled with a $3.6 million payback. As an offshoot of that probe, UW officials had to shut down three private foundations found to have been improperly operating within the med school for six years, run by a UW heart doctor and university personnel. Also in 1997, three conflict-of-interest allegations were sustained against a professor of radiation oncology, who had been accused of using his university position to benefit his private cancer center. Again that year, a lab department manager was sentenced to 11 months in jail for falsely submitting 40,000 hours of time-payment claims, amounting to more than $200,000—a fraud that went undetected for 19 years.
The latest scandal broke because whistle-blower Erickson, unable to stop the cheating within, he claims, went outside the system. UW officials think that was unnecessary, yet even then Winn still believed he could pull off an inside cover-up, obstructing a grand jury by telling fellow doctors that he had spies and would fire those who betrayed him and warning employees that "heads would roll" if they didn't lie about billing procedures. If he now serves as a symbol of change at the UW, so does Erickson. He has filed a federal False Claims Act lawsuit and, if joined by the U.S. in his action, can share in whatever funds the government recovers from the university. At a standard 10 percent to 20 percent, that could amount to more than $2 million. Let that be a lesson, too.
randerson@seattleweekly.com 
UW Medical Complex
Includes the School of Medicine, UW Medical Center, Harborview Medical Center, and UW Physicians neighborhood clinics.
Inpatients annually: 45,000.
Outpatients annually: 900,000
Faculty: 1,300.
Medical residents: 1,000.
Medicare funding, 2002: $58 million billed, $19 million paid.
Medicaid funding, 2002: $49 million billed, $15 million paid.
