Insurance Commissioner Intervenes in Sutter Anesthesia Billing Suit
Sacramento Business Journal – by Kathy Robertson, Staff writer
Date: Wednesday, April 13, 2011, 12:50pm PDT -
Insurance Commissioner Dave Jones announced that his office has intervened in a multimillion-dollar whistleblower lawsuit against Sutter Health for alleged false billing of anesthesia services.
Insurance Commissioner Dave Jones went to the streets of San Francisco Wednesday to announce that his office has intervened in a multimillion-dollar whistleblower lawsuit against Sutter Health for alleged false billing of anesthesia services.Also named in the lawsuit is Multiplan Inc., a New York corporation that acts as cost management intermediary between health insurers and hospitals, including those in the Sutter network. All Sutter hospitals and surgery centers appear to be named in court documents, including five hospitals in the Sacramento region.
The lawsuit alleges Sutter used an anesthesia code to charge for services and supplies that patients and their insurers had already paid for through other charges on the hospital bill or separate billing by the anesthesiologist. In some cases, court documents allege, the billing code was charged even though no anesthesiologist was present in the operating room or general anesthesia provided.
Rates apply to all Sutter hospitals and have increased over time, the lawsuit alleges.
“As a consequence, Sutter hospitals routinely charge, on average, $3,000 to $5,000 under the … code, when they are entitled to no more than $150 to $250 under that code, if anything,” court documents alleged.
Jones used his authority under the California Insurance Frauds Prevention Act to intervene in an existing lawsuit and bring action in the name of the state. He seeks triple damages for each claim, civil penalties of $10,000 for each violation, attorneys fees and court costs
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