A lawsuit unsealed Nov. 14 reveals Sacramento, Calif.-based Sutter Health settled allegations of a referral fraud scheme for $30 million — $5.8 million of which will be paid to the whistleblower who filed the case, according to a report from The Sacramento Bee.
According to the lawsuit, the whistleblower, Laurie Hanvey, was working at Sutter Health in 2012 as a compliance officer and noticed within the first 13 months of the job something was off with the time sheets and payments to local medical groups.
The lawsuit alleges one medical group, Sacramento Cardiovascular Surgeons Medical Group, was billing for more than 40 hours per week for five weeks per month, and also billed for vacation time as if it were spent working. The group allegedly had a deal with Sutter to receive free physician assistants, whose salaries were paid for by the health system, if they referred patients within the system, according to the report. It then also billed Medicare and other payers for services provided by the physician assistants, according to the lawsuit.
The lawsuit alleges similar arrangements were in place with other physician groups in the area, but those allegations have not been settled, according to the report.
Sutter Health did not admit wrongdoing and said the settlement resolves overpayments from CMS, according to the report.
Read the full story here.
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