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Sutter Health settles Medicare false claims civil case for $90M

Original post made on Sep 3, 2021

Sutter Health has agreed to pay $90 million to settle a civil lawsuit that alleged the company had overcharged a federal Medicare program.

Read the full story here Web Link posted Friday, September 3, 2021, 11:44 AM

Comments (13)

Posted by Neal
a resident of Community Center
on Sep 3, 2021 at 5:05 pm

Neal is a registered user.

No surprise here. I have been over billed on several occasions. I was once billed for three colonoscopies. They not only bill for procedures that weren't performed, they do what is called up coding. For example, if you had a short visit with your doctor they bill the insurance for a long visit which "justifies" a larger fee. Check your bills carefully for the correct service rendered and what they bill your insurance for. They used to include a medical procedure code number on the bill. You could Google the code number and find out precisely what you were billed for. They no longer put the code number on the bill in an attempt to conceal the truth.


Posted by Online Name
a resident of Embarcadero Oaks/Leland
on Sep 3, 2021 at 6:18 pm

Online Name is a registered user.

PAMF recently billed me for a "long" visit that's always been covered "because we'd "discussed too many topics" -- the same ones we always cover. I paid but questioned both PAMF billing and my doctor and got nowhere. Thinking my insurance might be screwed up I had my insurance folks check; insurance was fine and they got same "explanation."

A few months later I get a refund notice with no explanation, followed 15 minutes later with a "We miss you. Come see us" email.

My unexplained refund probably stems from the case.


Posted by Michelle
a resident of Stanford
on Sep 3, 2021 at 6:52 pm

Michelle is a registered user.

Not surprise at all.
I have to check all my charges with them, and in most cases they over charged. Hundred of dollars a year.


Posted by community member
a resident of University South
on Sep 4, 2021 at 12:52 pm

community member is a registered user.

So they overcharge patients and they also submit inaccurate information to Medicare.
They paid a 90 MILLION dollar fine on August 30, for KNOWINGLY overcharging Medicare, violating the False Claims Act. In SF federal court.

Sounds like a criminal organization, not a health organization.


Posted by Name hidden
a resident of Downtown North

on Sep 4, 2021 at 6:36 pm

Due to repeated violations of our Terms of Use, comments from this poster are automatically removed. Why?


Posted by community member
a resident of University South
on Sep 5, 2021 at 1:53 pm

community member is a registered user.

I'll be interested to see their PR response to the charges and the fine.
If any.


Posted by Online Name
a resident of Embarcadero Oaks/Leland
on Sep 6, 2021 at 8:09 am

Online Name is a registered user.

Community member, Sutter's statement from the last paragraph in this article:

Sutter Health officials said in a statement that the settlement and agreement, in which the company admitted no liability, "bring closure to a long-running dispute, allowing Sutter to avoid the uncertainty and further expense of protracted litigation, and enabling a constructive relationship with the government."


Posted by Tyler Cannon
a resident of Duveneck/St. Francis
on Sep 6, 2021 at 8:50 am

Tyler Cannon is a registered user.

>> "Sutter Health officials said in a statement that the settlement and agreement, in which the company admitted no liability, "bring closure to a long-running dispute, allowing Sutter to avoid the uncertainty and further expense of protracted litigation, and enabling a constructive relationship with the government."

^ Meaning: An out of court settlement agreement signifying a done deal, no further explanations required, or any admission of guilt on the part of Sutter Health.

Increases in premiums and reduced health services will help to cover the $90M outlay.


Posted by community member
a resident of University South
on Sep 6, 2021 at 8:51 pm

community member is a registered user.

That may be a legal statement for other lawyers, but I believe much more is required.

Like a promise to stop overcharging patients; and
a promise to stop inflating patient diagnoses in order to overcharge Medicare.

Publicize changes in staff and management and Board who oversaw the cheating and approved it.
Their statement just says it wants to stop "protracted litigation." Stop the cheating first, Sutter.


Posted by Consider Your Options.
a resident of Another Palo Alto neighborhood
on Sep 7, 2021 at 12:01 pm

Consider Your Options. is a registered user.

I can't stand Sutter Health. I badly miss the Palo Alto Medical Foundation of former years. Dealing with Sutter Health is an administrative nightmare. Their frontline workers--doctors, nurses, desk workers are fine (though much harder to access these days), but the organization's systems are designed to milk customers and insurance companies for fees. Now it appears they are dishonest, too. A vampire corporation should not be allowed to manage people's health care.

Heads should be rolling at the top. Hello, Sutter Health Board of Directors, are you listening? You just learned a very expensive lesson. It might actually be more profitable to treat people honestly and fairly. That would also help you hold on to and attract patients and excellent care providers.


Posted by cheese guy
a resident of Palo Verde
on Sep 8, 2021 at 9:46 pm

cheese guy is a registered user.

I just got a notice from Medicare that they denied a $500 charge that Sutter Health/PAMF tried to bill to Medicare Part B. What's the problem? I am not covered by Medicare Part B (only A, since I am fully employed and have good private insurance), but Sutter Health submitted a bill anyhow. Things like this seem to happen all the time with these weasels.


Posted by community member
a resident of University South
on Sep 13, 2021 at 4:25 pm

community member is a registered user.

I had a very simple message for my doctor. Spent over 1/2 hour on the web and could not find a way to write an email.
Finally called his office and waited 15 minutes till a nurse(?) answered.
She was polite and understood my message easily. whew.


Posted by community member
a resident of University South
11 hours ago

community member is a registered user.

Still waiting for a statement from Sutter about what they are changing
in order to stop cheating Medicare and over-billing patients. There must be a really corrupt culture there, with lots of people involved.

Maybe they figure the public will forget and they can just continue as before.
90 million dollars isn't easy to forget.


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