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SETTLEMENT AGREEMENT <br /> I. PARTIES <br /> This Settlement Agreement(Agreement)is entered into between the State of Washington <br /> acting by and through the Washington Attorney General's Office Medicaid Fraud Control Unit <br /> (AGO/MFCU),and the Washington State Health Care Authority(HCA)(collectively"the State"), <br /> and the City of Everett (the City), and all entities hereinafter collectively referred to as "the <br /> Parties." <br /> II. PREAMBLE <br /> As a preamble to this Agreement,the Parties agree to the following: <br /> A. At all relevant times,the City of Everett,a municipal entity located in Snohomish County <br /> in the State of Washington, operates a Fire Department Emergency Medical Services <br /> (EMS) program and entered into a provider agreement to provide EMS services to <br /> beneficiaries enrolled in medical service programs administered by HCA. Through its <br /> Fire Department, the City obtained reimbursements consisting of government funds by <br /> submitting claims for reimbursement for EMS procedures and services provided to HCA <br /> clients. <br /> B. The State alleges that the City submitted claims or caused claims for payment to be <br /> submitted to the Medicaid program administered by the Health Care Authority. The State <br /> further contends that claims may be submitted to HCA directly or through an <br /> intermediary,including a managed care organization(MCO). MCOs contract with HCA <br /> and the submission of claims for payment to an MCO constitutes the submission of <br /> claims to HCA. <br /> C. The State alleges that the City caused claims for payments to be submitted to the State's <br /> Medicaid Program (42 U.S.C. §§ 1396-1396(v)) in violation of RCW 74.09.210, RCW <br /> 74.66 et seq., Chapter 182-546 WAC. <br /> D. The State alleges that it has certain civil and administrative causes of action against the <br /> City based on the following conduct(the Covered Conduct): <br /> From January 1, 2010 through December 31, 2015,the City caused claims <br /> for EMS services to be presented to the Washington State Health Care <br /> Authority andits contractors, for payment in violation of RCW 74.09.21, <br /> RCW 74.66 et seq., Chapter 182-546 WAC. Some of the City's claims for <br /> payment were improperly coded at the Advanced Life Support(ALS) level <br /> of care. In particular, the City billed for ALS services where no qualifying <br /> ALS intervention was performed for an eligible client, and where the City <br /> only rendered Basic Life Support(BLS) services. The City also presented <br /> ALS claims for inter-facility transport without prior authorization. <br /> {AGS1604567.DOCX;2/13113.000005/} Page 1 of 7 <br />