Health Care Provider Billing Fraud

Report health care provider billing fraud in Washington State

Call: 1-888-811-5974 (option #4)

Health care provider complaint form.

Do you know of a medical provider who may be inappropriately billing workers compensation?

Spotting the red flags

Below are some behaviors that can indicate fraudulent activity by a health care provider:

Providers who….

  • Bill for services that did not occur.
  • Bill for non-covered services as a covered service.
  • Bill for more expensive services or procedures than were actually provided or performed.
  • Misrepresent dates of services.
  • Misrepresent location of services.
  • Misrepresent who actually provided the services.

Need help determining when to report?

Contact the provider fraud detection staff at 1-888-811-5974 (option #4) or providerfraud@Lni.wa.gov

Other health care provider concerns:

Report Interpreter concerns: Interpretation@Lni.wa.gov

Report Independent Medical Examiners (IME): Complain about an Independent Medical Examination (IME): Email IMEComplaints@Lni.wa.gov.

Report Quality of Care concerns: ProviderComplaint@Lni.wa.gov

Provider Fraud Penalties 

RCW 51.48.080 – Violation of Rules

Not to exceed $1,000.00.

RCW 51.48.250 – Liability of Persons willfully obtaining erroneous payments – Civil Penalties.

Not to exceed the greater of $1,000.00 or three times the amount of such excess benefits or payments.

RCW 51.48.260 – Liability of persons unintentionally obtaining erroneous payments.

Liable for:

1) any excess payment received; and

2) interest on the amount of excess payments at the rate of one percent of each month for the period from the date upon which payment was made to the date upon which payment is made to the state.

RCW 51.48.270 – Criminal liability of persons making false statements or concealing information.

Fine shall not be in an amount more than $25,000.00, except as authorized by RCW 9A.20.030.

RCW 51.48.280 – Kickbacks, bribes and rebates – Representation fees – Criminal liability – Exceptions –

Fine shall not be in an amount more than $25,000.00, except as authorized by RCW 9A.20.030.