Sutter Health in California Settling Medicare Allegations for $30M

A Northern California health care provider has agreed to pay $30 million to settle allegations that it overcharged the federal government for Medicare patient reimbursements.

Sutter Health didn’t acknowledge any liability in the settlement announced Friday by the U.S. Department of Justice.

Sutter Health is a Sacramento-based not-for-profit that has hospitals, affiliated health care foundations and other services covering more than 100 communities.

Federal officials alleged that Sutter submitted billing codes for some patients under Medicare Advantage plans, which are insurance plans managed by private organizations. The plans use so-called “risk codes” to determine reimbursements to the organizations for providing Medicare-covered services.

Authorities alleged that Sutter, which contracted with some Medicare Advantage groups, submitted diagnoses that inflated the risk codes and resulted in higher paybacks.

Topics California