DOJ says Sutter billed government payers for urine tests performed by third-party labs.
Sutter Health and its affiliate Sutter Bay Hospitals will pay the federal government more than $13 million to resolve civil allegations that the Sacramento-based health system billed Medicare and other government payers for thousands of urine tests that were performed by third-party labs, the Department of Justice says.
Federal prosecutors say that in 2016 and 2017 Sutter Health's Alta Bates Summit Medical Center in Oakland contracted with Navigant Network Alliance, LLC, under which Navigant referred to Sutter for analysis urine toxicology specimens collected from labs and doctors across the nation, which Sutter then billed the federal government.
"The United States asserts that Sutter did not perform the quantitative testing on thousands of specimens referred under the agreement and that these quantitative tests were instead performed by third-party labs… Sutter nevertheless sought reimbursement for the tests," DOJ says, and that the health system ultimately was paid for the tests by the Federal Employees Health Benefits Program, Medicare, Medicaid, and Tricare.
"Sutter Health agreed to pay $13 million to settle allegations that it billed government health programs for lab tests performed by others," says Stephanie Hinds, US attorney for the Northern District of California. "Government healthcare programs must be protected, and this office will investigate and pursue healthcare providers that fail to provide the services paid for by public healthcare programs."
Sutter has already paid $6.5 million of the $13,091,452 settlement and will pay the remaining $6.5 million within the next 30 days.
Sutter Health declined comment when contacted by HealthLeaders.
“Government healthcare programs must be protected, and this office will investigate and pursue healthcare providers that fail to provide the services paid for by public healthcare programs.”
Stephanie Hinds, US attorney, Northern District of California
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
KEY TAKEAWAYS
Feds say that in 2016 and 2017 Sutter Health’s Alta Bates Summit Medical Center in Oakland contracted with Navigant Network Alliance, LLC.
The contract called for Sutter to test urine specimens collected from labs and doctors across the nation, which Sutter then billed the feds.
Sutter has already paid $6.5 million of the $13,091,452 settlement and will pay the remaining $6.5 million within the next 30 days.
Sutter Health declined comment when contacted by HealthLeaders.