Sutter Health to pay $13M in settlement over improper billing
Sutter Health, a not-for-profit healthcare system based in Sacramento, has agreed to pay $13 million to settled allegations for violating the False Claims Act
The healthcare provider allegedly billed for toxicology tests from outside labs for government health programs.
“Sutter Health agreed to pay $13 million to settle allegations that it billed government health programs for lab tests performed by others,” U.S. Attorney Stephanie M. Hinds said in a statement. “Government healthcare programs must be protected, and this office will investigate and pursue healthcare providers that fail to provide the services paid for by public healthcare programs.”
According to the Department of Justice (DOJ), Sutter Health hospital Alta Bates Summit Medical Center entered into an agreement with Navigant Network Alliance, with Navigant sending urine toxicology specimens obtained from physicians and laboratories across the country to Sutter. Sutter then submitted bills for reimbursement of the testing performed on those specimens. Sutter did not perform the quantitative testing on thousands of specimens obtained this way, and the testing was instead performed by third-party labs. Between Aug. 1, 2016, and June 30, 2017, Sutter billed for urine toxicology tests it did not perform and was paid by Medicare, Medicaid and Tricare, the government contends.
“When medical providers charge federal health care programs for services that other providers actually performed, the integrity of these programs is undermined,” said HHS-OIG Special Agent in Charge Steven J. Ryan. “Working with our law enforcement partners, we will continue to uproot and investigate such schemes.”
Sutter has already paid $6.5 million to the U.S. of the $13,091,452 it has agreed to pay in the settlement. The settlement agreement resolves the civil law claims that the United States might have brought based upon these allegations.
Sutter Health recently appointed a new CEO and president, Warner L. Thomas. He assumes the new role Dec. 1.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."