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DOJ Takes Aim at Sutter Health, Claiming Inflated MA Risk Scores
Health Leaders: The federal government has intervened in a lawsuit against Sutter Health, taking the side of a whistleblower who claims the nonprofit health system inflated the risk scores of Medicare Advantage plan enrollees to secure higher risk-adjusted payments, the Department of Justice announced Tuesday.
The lawsuit alleges that Sutter Health, based in Sacramento, California, and its affiliated Palo Alto Medical Foundation knowingly submitted diagnosis codes that weren't supported by a patient's underlying conditions. Even after they became aware of the problem, they allegedly failed to make sufficient corrections.
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