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The DOJ announces a $ 90 million solution to the False Claims Act



Sutter Health, a health care provider in Sacramento, California and several affiliated entities, has agreed to pay $ 90 million to pay for violations of the False Claims Act by knowingly submitting inaccurate health information to recipients who are registered in Medicare Benefit Plans, the U.S. Department of Justice said on Monday.

The settlement is the largest settlement of false claims against a hospital system involving allegations of fraud in the Medicare Advantage program and the second largest reported Medicare Advantage fraud deal ever, according to attorneys representing a whistleblower in the case.

The DOJ statement said that Sutter Health contracted to provide health care services to beneficiaries in California who were enrolled in certain plans and in exchange received part of the payments for the treatment of the beneficiaries.

It said Sutter Health deliberately submitted unsupported diagnostic codes for some patients to a beneficiary counter during its care that caused inflated payments to be made to the plans and Sutter Health.

The DOJ's writ of summons required Sutter Health not to take corrective action after learning of this, nor to remove additional unsupported diagnostic codes after becoming aware of these unsupported diagnostic codes.

The Department of Justice said that in addition to paying the fine, Sutter Health and its subsidiaries have entered into a five-year corporate integrity agreement with the U.S. Department of Health and Human Services, the inspector general's office. which, among other things, requires Sutter Health to implement a centralized risk assessment program as part of its compliance program.

The Department of Justice said the settlement includes resolving whistleblower claims from Kathleen Ormsby, a former employee of the Palo Alto Medical Foundation, a Sutter Health subsidiary.

Sutter said in a statement that it looks forward to working with the Inspector General's Office on the terms of the Corporate Integrity Agreement. It said, "In 201

7, PricewaterhouseCoopers conducted an assessment of compliance programs that found Sutter's programs to be effective, with several areas identified as leading practices. Sutter has since maintained and improved these program elements and is well prepared to implement the terms of the agreement. [19659002] "Today's agreement closes a long-standing dispute, which allows Sutter to avoid uncertainty and additional costs for long-term disputes, and enable a constructive relationship with the government when we work together" according to the Corporate Integrity Agreement.

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