San Francisco, California – In a shocking turn of events, Sutter Health, a Sacramento-based healthcare services provider, and its affiliate Sutter Bay Hospitals, the successor to Sutter East Bay Hospitals dba Alta Bates Summit Medical Center (collectively Sutter Health), agreed to pay more than $13 million to settle allegations that it violated the False Claims Act by billing the United States for toxicology screening tests performed by outside labs.
According to the United States Attorney Stephanie M. Hinds, Sutter Health agreed to pay $13 million to settle allegations that it billed government health programs for lab tests performed by others. “Government health care programs must be protected, and this office will investigate and pursue health care providers that fail to provide the services paid for by public health care programs,” she said.
The FBI, in a statement, said that investigating health care fraud and abuse is a priority for the agency. “These cases are often worked in conjunction with our federal law enforcement partners, and this settlement is a great example of the multi-agency investigative team’s hard work to protect the integrity of the Federal Employees Health Benefits Program,” said FBI San Francisco Special Agent in Charge Robert K. Tripp.
The OPM OIG, in a statement, said that it is committed to protecting the Federal Employees Health Benefits Program from fraudulent claims. “I applaud the dedicated team for their effort in securing today’s settlement,” said OPM OIG Special Agent in Charge Amy K. Parker.
The HHS-OIG, in a statement, said that when medical providers charge federal health care programs for services that other providers actually performed, the integrity of these programs is undermined. “Working with our law enforcement partners, we will continue to uproot and investigate such schemes,” said HHS-OIG Special Agent in Charge Steven J. Ryan.
The DCIS Western Field Office, in a statement, said that today’s announced outcome concludes a collaborative effort to hold Sutter Health accountable for its improper billing practices that harmed our health care system, including the Department of Defense’s TRICARE program. “DCIS will continue to work closely with our law enforcement partners to protect the integrity of the health care system,” said DCIS Western Field Office Special Agent in Charge Bryan D. Denny.
The United States contends in the civil settlement agreement signed by Sutter Health that under the terms of a contract which the Sutter Health hospital Alta Bates Summit Medical Center entered into with Navigant Network Alliance, LLC, Navigant referred urine toxicology specimens obtained from physicians and laboratories across the country to Sutter. Sutter submitted bills, or caused bills to be submitted, for reimbursement of the qualitative and quantitative testing it performed on the specimens. The United States asserts that Sutter did not perform the quantitative testing on thousands of specimens referred under the agreement and that these quantitative tests were instead performed by third-party labs. The United States alleges that Sutter nevertheless sought reimbursement for the tests.
The settlement agreement was signed between August 1, 2016, and June 30, 2017, with Sutter billing for urine toxicology screening tests.
Mandatory Facts:
Defendant/Respondent: Sutter Health
Criminal Charges: Violation of the False Claims Act
City and State: San Francisco, California
Exact Date: N/A
Sentence or Outcome: Sutter Health agreed to pay $13 million to settle allegations
Dollar Amounts: $13 million
Related Federal Cases
- Omnicare Inc., False Claims Act Violations, Sacramento CA, 2023 · Massachusetts
- Frank Hamilton Sentenced to 5.5 Years for SBA Scam, California, 2023 · Texas
- Amy Evangelista, Tax Fraud, California 2023 · California
- FDIC Pushes Back GENIUS Act Stablecoin Application Deadline · Connecticut
- Federal Regulators, Lifel, Securities Fraud, California 2020 · Connecticut
Key Facts
- State: California
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
ðŸâ€Â’ Get the grimiest stories delivered weekly. Subscribe free →
MORE FEDERAL CRIME NEWS
US NewsUS NewsUS NewsUS News