April 12, 2019

California-based Sutter Health LLC and its affiliated medical foundations will pay $30 million to resolve allegations under the False Claims Act that they submitted unsupported diagnosis codes for certain patients, thereby inflating the the risk scores for those patients.  These inflated risk scores increased Medicare Advantage payments to Medicare Advantage Organizations with whom Sutter contracted.  Sutter’s contracts with the MAOs gave Sutter a share of those improper increased payments.  DOJ; USAO ND Cal; 2021 settlement on additional claims

Tagged in: FCA Federal, Healthcare Fraud, Managed Care, Risk Adjustment Fraud,