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Sutter, Palo Alto Medical Foundation accused of false Medicare claims

Diagnosis codes allegedly provided Sutter more money

The U.S. Attorney's Office has joined a lawsuit against Sutter Health and the Palo Alto Medical Foundation accusing the health care providers of knowingly submitting wrong or inaccurate diagnosis codes for some Medicare payments, the U.S. Justice Department announced on Tuesday.

The lawsuit alleges that Sutter and the Palo Alto Medical Foundation violated the federal False Claims Act by submitting inaccurate codes that inflated the "risk scores" of patients on the Medicare Advantage program and enabled Sutter to reap greater reimbursements from the Centers for Medicare and Medicaid Services, which oversees the Medicare program.

The lawsuit also alleges that when the Palo Alto Medical Foundation became aware of these inaccurate diagnosis codes, it failed to identify and delete additional potentially inaccurate codes that would result in a higher payment to Sutter.

Medicare beneficiaries have the option of enrolling in managed health care insurance plans called Medicare Advantage, also known as Medicare Part C. The plans are owned and operated by private Medicare Advantage organizations or MAOs. Medicare Advantage plans are paid a "per-person" amount to provide Medicare-covered benefits to the beneficiaries.

The Centers for Medicare adjusts the amount of the payment based on demographic information and the health status of each patient in the plan. A patient with more severe diagnoses has a higher adjusted amount, or "risk score." The government makes a larger payment to the Medicare Advantage plan for that patient, according to the Justice Department. Sutter allegedly submitted the inaccurate diagnoses codes for their patients to the insurers, who then submitted the codes to Centers for Medicare.

As a contracted provider to the insurer, Sutter receives a share of the payments to the insurers from Centers for Medicare.

The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, by Kathleen Ormsby, a former employee of the Palo Alto Medical Foundation. The False Claims Act permits private parties to sue on behalf of the government for false claims and to receive a share of any recovery. The act also allows the government to intervene or join in whistleblower lawsuits.

U.S. Attorney Alex G. Tse said in a statement that the government's participation in the lawsuit illustrates a commitment to protect the integrity of the Medicare Advantage program.

"The share of Medicare beneficiaries enrolled in Medicare Advantage has steadily grown over the past decade, with 19 million beneficiaries enrolled in 2017. It is critically important that the data submitted to the Medicare Advantage program is truthful because the government relies on this information to set payment levels. We will continue to guard government health programs from companies that improperly maximize their bottom line at taxpayer expense," he said.

Jody Hunt, assistant attorney general of the Department of Justice's Civil Division, said that federal health care programs rely on the accuracy of information submitted by health care providers to ensure that patients are afforded the appropriate level of care and that managed care plans receive appropriate compensation.

"Today's action sends a clear message that we will seek to hold health care providers responsible if they fail to ensure that the information they submit is truthful."

In an emailed statement from Sutter Health, company officials said, "Sutter Health and PAMF are aware of the matter and take the issues raised in the complaint seriously. The lawsuit involves an area of law that is currently unsettled and the subject of ongoing litigation in multiple jurisdictions. We intend to vigorously defend ourselves against the allegations in the complaint."

Similar cases

A Sept. 7, 2018, federal court ruling in D.C. District Court could work in Sutter's favor.

U.S. District Judge Rosemary Collyer overturned the 2014 Overpayment Rule set forth under the Affordable Care Act. Under the Overpayment Rule, or 60-day Rule, a Medicare Advantage organization must report and return any overpayment it received no later than 60 days after the date it identified receiving the overpayment.

The rule defines "overpayments," rules for reporting the overpayment and applicable fines and fees for non-compliance. Violators could face potential False Claims Act liability, other civil monetary liabilities and exclusion from federal health care programs for failure to report and return an overpayment. Damages can be triple the amount of the overpayments, and penalties can be between nearly $11,000 to more than $21,000.

But Medicare Advantage plans also contain more diagnosis codes than does traditional Medicare, which could lead to "overpayments" when compared to traditional Medicare costs for the same patient, the court noted. And while the False Claims Act applies to willful false coding, the Overpayment Rule has a broader standard under which it penalizes the Medicare Advantage organizations.

Collyer ruled that the Overpayment Rule can't use a different level of scrutiny for diagnosis codes in Medicare Advantage plans than it applies to overpayments in traditional Medicare plans.

But the issue is far from settled. The government could prove that Sutter “knowingly” provided false information, defined as having “actual knowledge,” or “acts in deliberate ignorance of the truth or falsity of the information,” or “acts in reckless disregard of the truth or falsity of the information,” standards required under the False Claims Act. If the government can make that case, the lawsuit could cost Sutter many millions of dollars.

A similar whistleblower case involving HealthCare Partners Holdings, which serves southern California, settled for $270 million in October. Like Sutter, HealthCare Partners, which was purchased by dialysis giant DaVita group, was also accused of submitting wrong diagnostic codes to the Centers for Medicare and Medicaid Services to obtain inflated payments.

DaVita, which purchased HealthCare Partners in 2012, voluntarily disclosed the diagnostic coding practices by HealthCare Partners after it discovered the situation, according to the Department of Justice. In the settlement, the companies did not acknowledge wrongdoing.

HealthCare Partners serves about 600,000 patients in California; parent company DaVita, which operates in California and multiple western states, has 1.7 million patients and more than 70,800 employees, according to its website.

Sacramento-based Sutter serves 3 million patients in California and Hawaii, according to its 2017 financial report. It has more than 53,000 employees and 5,500 affiliated doctors.

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Comments

32 people like this
Posted by Mycroft
a resident of Menlo Park
on Dec 12, 2018 at 11:16 am

Mycroft is a registered user.

I experienced a similar incident in billing from PAMF. The "coders" are part of their billing department, they have no medical training yet have discretion to "code" as they choose, interpreting at will any note made by a provider. When I questioned upon first receiving an $850 bill for a cursory 5 minute followup on a broken foot bone (which had been treated initially by a provider in SF for a total of $273, including boot, from the same X-ray CD I provided to the PAMF provider), the billing clerk with whom I twice spoke that day told me the "coder" had complete control over any interpretation and had refused(and is not required) to clarify or verify with the provider what service had actually been delivered. The coder made a medical determination which maximized the potential code fee and had absolutely no legitimate connection to the service. My option, I was told, was either to pay immediately - i.e. while on the telephone that moment - by credit card and receive a 30% discount!!! or pay the full fee at the normal due date. I was shocked by this entire exchange and shall never again by choice utilize PAMF. I can easily believe this same pattern of billing is employed to obtain government payments illegally and unethically at PAMF.


23 people like this
Posted by Coding error
a resident of Fairmeadow
on Dec 12, 2018 at 11:30 am

Coding error is a registered user.

I also experienced a coding error, via my daughter's broken arm. My bill reflected a large amount for creating a splint when all they did was stick a brace on her. I reported it to my insurance company, and after a month or two it was adjusted to the correct code. (And the insurance company was grateful to hear about it.) I only knew this because I have experience with broken arms, and knew what a real splint was. I cannot imagine having to deal with insurance claims for a more complicated illness. Just recently I was billed in full for an annual checkup because they mistakenly thought my doctor was out of network. This is all so, so, complicated, and prone to error.


9 people like this
Posted by Duveneck
a resident of Duveneck/St. Francis
on Dec 12, 2018 at 11:51 am

re Mycroft's experience. I had a similar experience, which I contested for several months. A phone call yielded the same response--pay up. But, no 30% reduction was offered!


27 people like this
Posted by criminal fraud
a resident of Fairmeadow
on Dec 12, 2018 at 12:05 pm

Sounds not unlike Florida Governor Rick Scott's company and the $1.7 Billion (with a 'b') FINE they paid. Yes, that was the FINE.

Scott was CEO of Columbia/HCA, when the hospital company was fined $1.7 billion for Medicare fraud. Of course, a criminal like that can no longer be a governor.

He was just elected to the US Senate.

The U.S. Attorney's Office should prosecute Sutter and PAMF to the full extent.



23 people like this
Posted by Sutter patient
a resident of Old Palo Alto
on Dec 12, 2018 at 12:08 pm

Recent experience with Urgent Care. HOURS of waiting. Referrals to many different staff and waits for each one. Over-specialization and over-prescribing.
Staff seems competent but they are in an inefficient system.
And the deluge of Evaluation surveys after a visit! Bizarre. Clearly looking for statistics for some corporate financial purpose.


17 people like this
Posted by Barbara
a resident of Downtown North
on Dec 12, 2018 at 12:18 pm

Unfortunately, there are few, if any, private practice physicians available - only those under the umbrella of huge facilities. What a shame!!


21 people like this
Posted by Health Care Is a Business
a resident of Embarcadero Oaks/Leland
on Dec 12, 2018 at 1:32 pm

> Over-specialization and over-prescribing. Staff seems competent but they are in an inefficient system.

PAMF requires its MDs to rack-up as many billable hours possible (including referrals to other specialists) & their productivity is measured on those terms.

Similar to lawyers.

> Unfortunately, there are few, if any, private practice physicians available - only those under the umbrella of huge facilities.

Yes. Private practice MDs are definitely becoming rarer these days.


7 people like this
Posted by Novelera
a resident of Midtown
on Dec 12, 2018 at 2:46 pm

Novelera is a registered user.

Yikes! I've been glad for some time that I have straight Medicare, Part D, with a supplement for what that doesn't cover. I was told that Medicare Advantage programs benefit private companies and actually the Medicare system somehow gets less money.

This profit motive kind of explains why I get dozens of mailers about Sutter Health's medicare advantage plan starting in November.

I am a patient at PAMF, but have never had any problems with my bills. Medicare pays what they pay and Blue Shield picks up the rest.

And I am completely satisfied and happy with my internist and the battery of specialists I've used over the years. All have been really wonderful.


23 people like this
Posted by The problems started with Sutter Health.
a resident of Duveneck/St. Francis
on Dec 12, 2018 at 2:50 pm

The problems started with Sutter Health. is a registered user.

I never had any problems with PAMF until Sutter Health came along. Suddenly I had to wait for ages for a human to answer the phone. Billing became a nightmare. They started scheduling my doctor appointments in other towns--causing me to spend an hour or more in the car when I'd never had to do that before. My doctor left the clinic.

My new doctor is fine and quality of medical care seems to be mostly unchanged, BUT the administrative work is now awful.


12 people like this
Posted by Anonymous
a resident of Duveneck/St. Francis
on Dec 12, 2018 at 8:41 pm

Speaking of the bureaucratic angle (not fraud), read Dr. Atul Gawande’s fascinating article in The New Yorker, “The Upgrade - why doctors hate their computers,” November 12, 2018 issue. Eye-opening, helpful for patient awareness of what’s happening with computerization of medical records/systems. I highly recommend this article.


3 people like this
Posted by Novelera
a resident of Midtown
on Dec 13, 2018 at 8:08 am

Novelera is a registered user.

@Anonymous Duveneck/St. Francis

Thanks for the recommendation of the Atul Gawande article. He's one of my favorite non-fiction writers. I get the digital New Yorker, and thankfully that issue was still in my inbox.


17 people like this
Posted by anonymous
a resident of Los Altos
on Dec 13, 2018 at 8:17 am

Patients are harassed by Palo Alto Medical with solicitation telemarketing calls and emails for exams and everything else they do. Palo Alto Medical wants patients to keep getting as many services as they can to get as much money from insurance and patients. When Sutter took over, it turned all about profit for so called not for profit place. My friend went to Sutter for sore throat but doctor told her needs a physical. She got physical and referred to other departments for minor symptoms. One year later after many appointments, tests, lots of money from insurance and patient, nothing was found.
Sutter treats patients like a piggy bank.


14 people like this
Posted by Retired MD
a resident of Stanford
on Dec 13, 2018 at 9:10 am

>> Unfortunately, there are few, if any, private practice physicians available - only those under the umbrella of huge facilities.

Yes. The days of Marcus Welby, MD are long gone.

Today every doctor is a 'specialist' of some kind as even the traditional family general practitioner went the route of Internal Medicine long ago.

The job title = more money. And the patients = just another billable file.

It wasn't always that way.



41 people like this
Posted by PAMF Employee
a resident of Another Palo Alto neighborhood
on Dec 13, 2018 at 1:31 pm

The poster "The problems started with Sutter Health" has it right on the money. Founder Dr. Russell Lee would not recognize the current organization. Dr. David Druker sold PAMF out to Sutter. The old PAMF prior to 2008 was a fabulous organization. Sutter is only retaining the PAMF name for marketing purposes. Sutter has reduced appointment times, so if you feel more rushed than you used to, there's a good reason for it. PAMF is having a crisis of leadership. The current CEO is acting only, and the prior one, Dr. Maser, left very suddenly and no one knows why. I'm guessing because he was slow to implement changes that would cheapen the values of the organization. In addition to this Medicare fraud problem, Sutter is being sued for antitrust by the CA Attorney General, Xavier Becerra. Sutter has been very aggressive in buying up small medical practices all over Northern California.

Over the last ten years, PAMF has outsourced many functions such as mailroom, security, janitorial services, pharmacy etc. It made me very sad to see many loyal, longtime employees including Greg the mailman forced out, he was the soul of the old PAMF, a super friendly guy who would do anything for you. Employees in these groups were forced to interview for their old jobs at a fraction of the pay. Facilities is not keeping up with repairs and the place is looking shabby. As I am also a patient at PAMF, I'm alarmed by all the broken and nonfunctioning medical equipment I am encountering during my medical appointments. I used to be proud and excited to work there. Now PAMF is just another cost cutting, revenue hungry corporation, one that keeps boasting it is not for profit, while paying no taxes and making plenty of profit. Think of Sutter Health as a health care holding company with huge salaries going to the executives in Sacramento.

I'm delighted that the Weekly is publishing this story because despite all of the very significant changes taking place at PAMF over the years, the Weekly hasn't paid much attention to this highly valued community asset. I hope the Weekly will do more to expose Sutter's business practices. Thanks so much for this article Sue!


15 people like this
Posted by former employee and patient
a resident of another community
on Dec 14, 2018 at 1:09 am

Sutter Health Management Leadership has been discreditable for long time. It has been friends hiring friends and family. This traditional hiring is disastrous for clinics, workers and patients. If Sutter wants to survive and prevent lawsuits, CEO must get rid of all existing managers and leaders and hire new moral ones from scratch. Former manager was queen bee but there are more in the greater Sutter hive. They make the immoral decisions affecting workers and patients. Sutter Health is like a bad cult. Those keeping silent and going along with Sutter Land survive. Those speaking out are expelled.


5 people like this
Posted by Anon
a resident of Another Palo Alto neighborhood
on Dec 14, 2018 at 11:14 am

Does the -Foundation- actually still exist as a functioning entity? Or is it just a year-end donation vehicle? If there is an existing, functioning board that actually has some backbone, "knowingly submitting wrong or inaccurate diagnosis codes for some Medicare payments" surely is a contract violation. The board should strongly consider dumping Sutter.


3 people like this
Posted by Sutter patient
a resident of Old Palo Alto
on Dec 14, 2018 at 1:17 pm

Just received ANOTHER survey this one on the phone. Long repetitious instructions and introductions.
Very unpleasant,
So I am receiving many 1) email surveys, 2) regular mail surveys, and 3) telephone surveys.

What kind of manipulation is going on?
Cant help wondering if they count each response as a separate person. Given their proven dishonesty, this is possible.


26 people like this
Posted by Sutter Health Representative
a resident of another community
on Dec 14, 2018 at 1:52 pm

[Post removed due to same poster using multiple names]


21 people like this
Posted by Me too
a resident of Another Palo Alto neighborhood
on Dec 14, 2018 at 9:16 pm

The billing department at PAMF defrauds also people who have private insurance. In one such case, I escalated an obviously incorrect claim to a supervisor, who not only did not fix the problem, but had the audacity to tell me that if I don't like the way I am treated, I can go seek medical help somewhere else.
Not surprised to read the tone-deaf comment of Sutter Health representative above.


6 people like this
Posted by Sutter Patient
a resident of another community
on Dec 15, 2018 at 12:00 pm

Last week I ask for two refills for two medicines but my brand new primary doctor say to get yearly physical. My last doctor for so years never tell me this and sent me to lab for levels and then give me refills without bull shit waste for insurance and my money. No physical every time cause he said no need for healthy man like me. I got one every three years or a short appointment. Now they tell me I got to get one once a year to get refills. I have to take time off from work and drive far to get to the clinic.
Sutter gives papers to tell physical exam billing for two charges in one appointment but no waivers to tell physical appointment does not 100% promise we will live long time, not get sick and not die. My brand new primary doctor lie with promises to explain why to get physical. This is 100% unethical on his part and Sutter. I make my family promise to file lawsuit if I die after getting yearly physical. Sutter doctors do not tell negative side effects. My health account said OVERDUE but it is 100% unethical to say this. Sutter give false security to patients and feed off their fears of dying. 100% UNETHICAL AND DECEIT. What good is our health if Sutter destroys it with lies of promises of reasons to get physicals and referrals. Sutter got Mission, Vision & Values on their website but they are lies to the people.


32 people like this
Posted by Not Exactly...
a resident of Adobe-Meadow
on Dec 15, 2018 at 2:15 pm

[Post removed due to same poster using multiple names]


2 people like this
Posted by musical
a resident of Palo Verde
on Dec 15, 2018 at 2:50 pm

> conscious of their overall appearance

Explains why mirrors in public facilities are always vandalized.


12 people like this
Posted by Ex Sutter Patient
a resident of Egan Middle School (Los Altos)
on Dec 15, 2018 at 6:16 pm

We got to get social health care system in America because corporate business greed and medicine must never mix together. Sutter among all big health network groups are all now about profit over patients while the CEOs earn millions of dollars annually. There are patients rights but Sutter doctors ignore them and are told to generate many billable charges to get more shares. The opinion of weight and appearance is irrelevant.


37 people like this
Posted by Nutritionist/Stanford
a resident of Stanford
on Dec 15, 2018 at 7:01 pm

> The first step to better health is watching one's weight and being conscious of their overall appearance.

This makes sense...from an overall health standpoint.

> The opinion of weight and appearance is irrelevant.

This also makes sense...to the unconcerned.





17 people like this
Posted by I Avoid PAMF & Go to My Vet Instead
a resident of Woodside
on Dec 16, 2018 at 2:15 pm

[Post removed due to same poster using multiple names]


2 people like this
Posted by Anon
a resident of Another Palo Alto neighborhood
on Dec 16, 2018 at 4:46 pm

Posted by I Avoid PAMF & Go to My Vet Instead, a resident of Woodside

>> It's probably unethical from a doctor's standpoint but...whenever I need a regular check-up, I just go to my horse's veterinarian. Except for a few examinations which are exclusive to livestock, the routine is basically the same.

Interesting idea, but, recently, vets have gotten as expensive as MDs around here. Is your vet somewhere in the south county?


25 people like this
Posted by Sutter patient
a resident of Old Palo Alto
on Dec 17, 2018 at 11:23 am

> The first step to better health is watching one's weight and being conscious of their overall appearance.

Is there any attention paid to health of the staff?

Morbid obesity is all over the clinic. It may be a response to difficult working conditions or unhealthy food in their cafeteria. But it is disconcerting to see so much obesity.


17 people like this
Posted by Anneke
a resident of Professorville
on Dec 17, 2018 at 12:51 pm

For six years I have gone through a medical nightmare. I started with doctors at PAMF, but decided after half a year to leave for a different institution. I can only describe my medical experience in the following analogy: if you do good and thorough research, the solution will most often fall into place; if you don't do good research and just guess at the solution, you will most often make the wrong solution, which will take you further away from where you were, and it is much more difficult to turn it around.

I remember one doctor at PAMF telling me that for common conditions PAMF is fine, but not for more difficult ones....

Also, Dr. Diana Blum, a wonderful patient-oriented neurologist, took PAMF to court. According to Dr. Blum's lawsuit, doctors at the practice were "encouraged to characterize ailments as more complex, so the group would bill insurers at higher rates."

And now comes the unbelievable: Dr. Blum won the case, but PAMF is going after her for 1.4Million in legal fees.

Web Link

No wonder the US is NOT on the list of the top 19 best medical care countries in the world. It is time the US takes a good look at these countries and implement similar successful methods.


27 people like this
Posted by Personal Appearance Does Matter
a resident of Adobe-Meadow
on Dec 17, 2018 at 1:24 pm

[Post removed due to same poster using multiple names]


15 people like this
Posted by neighbor
a resident of another community
on Dec 17, 2018 at 2:51 pm

Writers self-righteously going after obese workers at PAMF are WAY OFF TOPIC. The topic was PAMF's fraudulent coding of medical conditions to rip off Medicare. This actually happened to me twice at PAMF.


6 people like this
Posted by PA Resident
a resident of Gunn High School
on Dec 17, 2018 at 9:10 pm

[Post removed due to deletion of referenced comments.]


21 people like this
Posted by Past Coding Employee
a resident of another community
on Dec 17, 2018 at 10:33 pm

Human Resources, managers and supervisors take revenge on whistleblower workers even though the policy says they are not to do that. Some doctors want to say something but fear losing their good salaries and so they keep up with unethical ways of Sutter including Medicare fraud. They demand medicare check ups often in order to add extra diagnosis codes, extra referrals and extra services of all kinds.
Diana Blum is a braveheart and did not give into Sutter's unethical ways but got punished by Sutter to repay legal fees. The couple that donated millions to Sutter are so ignorant, should ask for a refund and not want their names connected to Sutter.


22 people like this
Posted by Donuts Not OK For Local LEO
a resident of Duveneck/St. Francis
on Dec 18, 2018 at 7:59 am

[Post removed due to same poster using multiple names]


14 people like this
Posted by anneke
a resident of Professorville
on Dec 18, 2018 at 11:15 am

I totally agree with the post from "Neighbor." Please look at the title. Am I in agreement that people should take better care of their health, of course! But that is not the issue here.

The issue is fraudulent behavior by Sutter-PAMF, the burden of which seems to be put on the Billing Department. I don't know who is responsible for putting the treatment codes in, but I somehow believe the doctors are responsible for that, not the clerks in the Billing Department. In fact, we worked with a Billing clerk at PAMF in Palo Alto on a small issue, and she was great!

I have sometimes wondered if the Hippocratic Oath that is sworn to by all Medical Doctors has changed over time into "The Hippocritic Oath." A major part of the Hippocratic Oath is based on honesty and that seems to be lacking within Sutter PAMF.


16 people like this
Posted by Wishing Everyone Good Health Care
a resident of Embarcadero Oaks/Leland
on Dec 18, 2018 at 12:54 pm

[Post removed due to same poster using multiple names]


15 people like this
Posted by resident
a resident of Mayfield
on Dec 19, 2018 at 7:59 am

To the people writing about weight issues, please stick to the subject of PAMF's Medicare fraud claims. If you all do not know what to say about this topic, don't say anything more and get offline. What PAMF does on claims and everything else bad is no laughing matter. The founders would be rolling in their graves by the Sutter corporate business greed takeover.


6 people like this
Posted by Getting It Done At PAMF
a resident of Portola Valley
on Dec 19, 2018 at 9:33 am

[Post removed due to same poster using multiple names]



9 people like this
Posted by neighbor
a resident of another community
on Dec 19, 2018 at 10:32 am

Geez, some folks are stubborn. Start your own thread about weight. The article and this thread is about shady PAMF billing practices.

BTW.....all of my billing issues were discussed on the phone. PAMF personnel never saw what I looked like.


8 people like this
Posted by sunshine
a resident of Barron Park
on Dec 19, 2018 at 1:06 pm

I tried PAMF and when they were in the old building (soon to be History Museum), they were good, especially the doctor I used in neurology. I have also been to Stanford and doctors associated with groups in that area. I found them a bit over priced.
Now I go to Kaiser in Mt View. My doctor is good and tries to use the least expensive way to take care of me. There is always a replacement if she is on vacation.
I recommend Kaiser in Santa Clara county. I have heard from others and observed personally that they keep trying to find the best way to deal with each medical problem. The cost is also not outrageous.


12 people like this
Posted by GrandmaKK
a resident of Midtown
on Dec 20, 2018 at 12:50 pm

After a years long dispute with our insurance, they admitted they had been wrong (!!) and agreed to reimburse us. However, they instead sent thousands to the providers they incorrectly charged. Stanford has sent us checks for the money reimbursed. Sutter refuses to reimburse us, instead keeping the money. There is no one in Palo Alto at the Palo Alto Medical Foundation to speak with or meet with to discuss the matter. Phone calls to Sacramento are all we can do. They are useless - the calls and Sutter!


4 people like this
Posted by Anon
a resident of Another Palo Alto neighborhood
on Dec 20, 2018 at 4:38 pm

Coincidentally, I just received a large, slick magazine in the mail, "Foundation for Health", which seems to be deliberately downplaying the PAMF Foundation part, and, equating it with Sutter Health. What exactly is the relationship of Sutter Health to PAMF? Does PAMF still have a separate identity from Sutter Health?

In any case, too bad Kaiser hasn't built a hospital in Palo Alto. We could use a lower-cost alternative to Sutter and Stanford.



Like this comment
Posted by PAMF patient since 1973
a resident of Mountain View
on Feb 4, 2019 at 1:58 am

I have experienced inaccurate (overcharge) Medicare billings by PAMF-PA Rheuatolgoy in 2016, PAMF-PA PT in 2017 and most recently 2 out of the 6 appointments with OT at the PAMF-Sunnyvale PT, which I just pointed out to the O.Therapist who acknowledged, apologized, and said she would correct it. It's the MD who submits the Dx and Tx codes; that's where the ethics ownership belongs.
The Camino group culture was so refreshing at a time when PAMF became increasingly arrogant, and when most of my finest original PAMF MD's were retiring.


3 people like this
Posted by Dr. Killdare
a resident of another community
on Feb 5, 2019 at 6:32 am

The opaque American medical billing system is theft, violence and genocide against Americans. How this outrage continues to go on while on the other hand we talk about free markets and capitalism is mystifying, but it is backed up my private media like this here and the other systems of computational propaganda systems in place to direct people's attention.

Health Care Must Be A Human Right - Universal Single Payer Health Care For All Americans/


2 people like this
Posted by AAPC CPC Coder
a resident of another community
on Mar 3, 2019 at 12:04 pm

There are multiple billing investigations ongoing as to PAMF and Sutter's institutional upcoding and unbundling of claims, some with false cancer diagnosis, both of Medicare and Non-Medicare patients. These are verified and true claims of false coding by PAMF for unjust enrichment. I am an AAPC CPC coder and would be interested in connecting with former PAMF and Sutter billers and coders like the Post by Past Coding Employee on Dec 17, 2018. Please contact me by email judyjones455 at yahoo for discreet information.Your input would be very helpful in
ensuring Sutter and PAMF stop billing and collecting fraudulently.


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