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Sutter Health – Healthcare Fraud/Medicare Advantage ($90 million)

Constantine Cannon represented a whistleblower in a False Claims Act case alleging Sutter Health and its affiliates inflated the number and severity of Medicare Advantage patient diagnoses, manipulated patient records, ignored audit red flags, and engaged in other misconduct to increase patient risk scores and obtain Medicare Advantage payments to which they were not entitled.  In August 2021, Sutter agreed to pay $90 million to settle the matter, the largest Medicare Advantage False Claims Act settlement to date against a hospital system, and at the time, the second largest reported Medicare Advantage fraud settlement ever.  Our client received a whistleblower award of roughly $22 million.  Read more -- AP, Reuters, SF ChronicleDOJ, PR NewswireCC.

Group Health Cooperative - Healthcare Fraud/Medicare Advantage ($6.375 million)

Constantine Cannon represented a whistleblower in a False Claims Act case alleging Group Health Cooperative (now a subsidiary of Kaiser Permanente) submitted false or inaccurate Medicare Advantage patient diagnosis codes to inflate the reimbursement it received under the Medicare Part C program.  In November 2020, the company agreed to pay $6.375 million to settle the matter.  Our client received a whistleblower award of 25% of the government's recovery.  Read more -- NPR, Seattle Times, DOJ, CC.

Freedom Health/Optimum - Healthcare Fraud/Medicare Advantage ($32.5 million)

Constantine Cannon represented a whistleblower in a False Claims Act case alleging Freedom Health and Optimum Healthcare inflated their Medicare Advantage patient risk scores to secure artificially high Medicare reimbursement.  In May 2017, the companies agreed to pay $32.5 million to settle the matter.  Our client received a whistleblower award of roughly $6.4 million.  Read more -- NPRMiami Herald, DOJ, CC.