An Oregon Department of Justice investigation into Providence Health & Services over alleged improper billing has continued for more than a year without resolution.
At issue is whether the nonprofit health system — Oregon’s largest operator of hospitals — improperly billed thousands of members of the Oregon Health Plan, which provides free, Medicaid-funded care to more than 1.3 million low-income Oregonians.
“Health care providers are not permitted to bill Oregon Health Plan members for services covered by the state’s Medicaid program,” said Robb Cowie, a spokesperson for the Oregon Health Authority. “At this time, we can confirm that the Oregon Department of Justice has an open consumer protection investigation into Providence.”
A spokesperson for Providence said the health system is cooperating. After being informed of the state’s preliminary findings more than a year ago, he said, “Providence immediately began engaging with OHA to respond to the inquiry and provide relevant data, keeping with our commitment both to transparency and to prioritizing care of vulnerable patients.”
A spokesperson for Oregon DOJ declined to comment other than to confirm an open investigation.
The preliminary findings of the state investigation were that Providence improperly billed more than 108,000 people, The Lund Report has learned.
However, Providence responded to the findings that the state’s numbers calculated by the Oregon Health Authority were false and included billings for procedures not covered by the state, records show.
The probe has its roots in a lawsuit filed by the Washington state Attorney General in February 2022 accusing Providence of unfair and deceptive collection practices targeting the poor. As The Lund Report reported at the time, the suit quoted from emails sent by Providence officials overseeing Oregon, but the Oregon Department of Justice had not opened an investigation.
In September of 2022, the New York Times conducted its own investigation based on the Washington suit, and reported on alleged victims in Oregon. The following month, the Oregon Department of Justice confirmed it had opened a file on the matter in April.
Records obtained by The Lund Report show that the Oregon Health Authority informed Providence of potential inappropriate billings in October of 2022, then followed up on Feb. 23, 2023, citing a figure of more than 108,000 members of the Oregon Health Plan that appeared to have been inappropriately billed.
On Feb. 27, Providence’s Washington, D.C. attorney, Andrew Wright of K&L Gates, responded that the state’s numbers included billings not just of OHP members but of OHP directly, saying he wished to “respectfully disagree” with the state's characterizations. Not only that, but some of the state’s count included procedures that are not covered under OHP, and “as reflected in your letter, there are a number of circumstances under which OHP members can properly be billed.”
He added, “in addition to reiterating Providence’s desire to fully address your requests, we also want to emphasize Providence’s commitment to its Medicaid patients. Providence has been a leader in advocating for Medicaid expansion policies that have significantly broadened access to care for the poor and vulnerable across the states it serves … Providence considers its community benefit program, including care for Medicaid patients, to be central to its mission.”
State officials declined to provide their current estimate of potential improper billings.
