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 Chronicle, DOJ, PR Newswire, CC.

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