Sutter Health, Medicare Advantage Fund Overpayment, California 2023
A California-based healthcare services provider, Sutter Health LLC, and its affiliated entities, Sutter East Bay Medical Foundation, Sutter Pacific Medical Foundation, Sutter Gould Medical Foundation, and Sutter Medical Foundation, have agreed to pay $30 million to settle allegations that the affiliated entities submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans, resulting in the plans and providers being overpaid.
According to the Justice Department, Sutter Health, a non-profit public benefit corporation that provides healthcare services through its affiliates, including hospitals and medical foundations, contracted with certain Medicare Advantage Organizations (MAOs) to provide healthcare services to California beneficiaries enrolled in the MAOs’ Medicare Advantage Plans.
The settlement resolves allegations that Sutter and its affiliates submitted unsupported diagnosis codes for certain patient encounters of beneficiaries under their care, inflating the risk scores of these beneficiaries and resulting in the MAO plans being overpaid.
The Medicare Advantage Program provides benefits to a significant portion of federal healthcare beneficiaries. The Justice Department will help ensure that accurate information is supplied to the Medicare Advantage Program by plans and providers and pursue appropriate remedies when it is not.
Sutter Health is headquartered in Sacramento, California.
The settlement was the result of a coordinated effort by the Civil Division’s Commercial Litigation Branch, the United States Attorney’s Office for the Northern District of California, and HHS-OIG.
The claims resolved by the settlement are allegations only, and there has been no determination of liability.
Mandatory Facts:
- Defendant: Sutter Health LLC and affiliates
- Criminal Charges: Allegations of submitting inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans
- City and State: Sacramento, California
- Exact Date: N/A (settlement announced)
- Sentence or Outcome: $30 million settlement
- Dollar Amount: $30 million
Key Facts
- State: California
- Category: White Collar Crime
- Source: DOJ Press Release â†â€â€
ðŸâ€Â’ Get the grimiest stories delivered weekly. Subscribe free →
MORE FEDERAL CRIME NEWS
White Collar CrimeWhite Collar CrimeWhite Collar CrimeWhite Collar Crime