Calif. joins suit against Sutter Health, alleges fraud charges for anesthesia

The San Francisco Chronicle: Sutter Health Accused Of Fraud By State
Sutter Health, one of California's largest health care givers, fraudulently charged insurers up to hundreds of millions of dollars over the past decade for anesthesia services that in some cases weren't even provided, the state's insurance commissioner said Wednesday (Allday, 4/14).

The Sacramento Bee: California Joins Insurance Fraud Lawsuit Against Sutter Health
Sutter charges as much as $5,000 for anesthesia services when it is entitled to no more than $250, according to the motion. "These charges so far exceed actual costs that it is clear Defendants are actually double-billing for costs captured in the anesthesiologist's bill … or are simply billing for services not actually provided," the commissioner's complaint read. In the statement from Sutter, officials said the prices reflect the costs of complying with the state's earthquake retrofit requirements, improving technology and caring for increasing numbers of patients who are unable to pay. "Our contracts with health insurance plans are thoroughly negotiated with these sophisticated companies," the statement read. "Since these rates are negotiated, they cannot be fairly characterized as false after the fact" (Smith, 4/14).

Modern Healthcare: Calif. Insurance Commissioner Joins Whistle-Blower Lawsuit Against Sutter Health Insurer
The insurance commissioner of California has joined a whistle-blower lawsuit against Sutter Health and a managed-care company, alleging that they fraudulently manipulate anesthesia billing codes and drive up overall healthcare costs. The 31-page motion alleges that Sutter, along with MultiPlan, New York, and other payers and providers, routinely bill for anesthesia services even though the services are either not provided or are paid for directly through anesthesia providers who don't work for the hospitals. Sutter denied the allegations and vowed to vigorously defend itself. ... State Insurance Commissioner Dave Jones joined the lawsuit as a plaintiff on Wednesday and said the case could extend to hundreds of other providers and payers that employ similar billing procedures (Carlson, 4/14).