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A Northern California health care provider has agreed to pay $ 30 million to settle the federal government's overcharging charges for Medicare patient reimbursements. Sutter Health has not acknowledged its responsibility in the settlement announced Friday by the Justice Department of the United States. Federal officials said Sutter had submitted billing codes for some patients under Medicare Advantage plans, which are insurance plans run by private organizations. Plans use "risk codes" to determine reimbursements to organizations that provide services covered by Medicare. The authorities claimed that Sutter, who had a contract with certain Medicare Advantage groups, had submitted diagnoses that inflated the risk codes and resulted in higher benefits.
A health care provider from Northern California has agreed to pay $ 30 million to settle the allegations of additional cost to the federal government for Medicare patient reimbursements.
Sutter Health has not acknowledged any liability in the settlement announced Friday by the US Department of Justice.
Sutter Health is a nonprofit organization based in Sacramento. It has hospitals, affiliated health care foundations and other services covering more than 100 communities.
Federal officials said Sutter had submitted billing codes for some patients under Medicare Advantage plans, which are insurance plans run by private organizations. The plans use "risk codes" to determine reimbursements to organizations for the provision of services covered by Medicare.
Authorities said Sutter, who had contracted with some Medicare Advantage groups, had submitted diagnoses that boosted risk codes and resulted in higher payback times.
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