The CIA requires Sutter Health to implement a centralized risk assessment program as part of its compliance program. It also requires the hospital system to hire an Independent Review Organization to check a sample of the medical records and related diagnoses data of Medicare Advantage beneficiaries.
Sutter Health also agreed to pay $90 million, plus applicable accrued interest to the United States government. The hospital system already paid $30 million. Interest at a rate of 0.875% will only accrue on the remaining $60 million from December 4, 2020, until the date of payment in full is made.
In a statement, DOJ Civil Division Deputy Assistant Attorney General Sarah Harrington said, “Today’s result sends a clear message that we will hold health care providers responsible if they knowingly provide or fail to correct information that is untruthful.”
On the other hand, Acting U.S. Attorney Stephanie Hinds for the Northern District of California commented, “Today’s settlement exemplifies our commitment to fighting fraud in the Medicare program. Health care providers who flout the law need to know that my office will hold accountable those who pad their bottom line at taxpayer expense.”
