Sacramento, Calif.-based Sutter Health may be liable for up to $519 million in a case involving alleged double billing and unnecessarily expensive post-op treatment, a Sept. 20 Law360 report said.
The whistleblower suit that is expected to last about a month alleges Sutter Health has since late 2013 performed nerve-blocking procedures in operating rooms without consistent documentation, and then overcharged for post-treatment services that may not actually have been given.
Charges for nerve blocks done in an operating room are regularly more than double the amount if done outside the OR, the suit claims. One of the plaintiffs is a retired former orthopedic surgeon who worked within the Sutter Health system.
Sutter Health lawyers dispute the claims, describing the 28-hospital system as having "no profit motive."
The health system issued the following statement on the case.
“Sutter will show at trial that this case has no merit, and the bills plaintiffs claim violate the law are compliant, accurately reflect the services Sutter provided to patients, and are consistent with the national billing guidelines required by insurance companies," according to the statement. "The State Department of Insurance chose not to intervene in this matter, despite being presented with the opportunity to do so, and insurance company witnesses support the billing methodology plaintiffs claim is unlawful."
Sutter Health, which reported an operating gain of $29 million in the second quarter, is also involved in two other lawsuits totaling a possible $650 million.