Two California Health Systems Settle Medicare Overbilling Allegations

On Wednesday, the U.S. Attorney's Office in Sacramento announced that Catholic Healthcare West and Sutter Health paid $2.3 million to the federal government to settle claims that they improperly billed the federal government more than once for the same medical services, the AP/San Francisco Chronicle reports (AP/San Francisco Chronicle, 12/7).

Details of Allegations

According to federal officials, the two health care systems overcharged Medicare by:

• Duplicating charges for infusion therapy, which usually involves the administration of a drug intravenously;
• Billing separately for infusion therapy services when they should have been billed as a group; and
• Duplicating charges for lithotripsy, which is a treatment to break up stones in the kidney and other parts of the body.

According to federal officials, the investigation of Sutter's activities covers the period between Jan. 1, 2002, and March 31, 2008, while the CHW investigation covers the period from Sept. 3, 2003, to Dec. 31, 2007 (Robertson, Sacramento Business Journal, 12/7).

Thirty-six CHW facilities in California, Arizona and Nevada were involved in the investigation, while the 25 Sutter Health hospitals involved in the investigation are located in Northern California (AP/San Francisco Chronicle, 12/7).

Details of Settlement

CHW paid $875,564 and Sutter Health paid more than $1.43 million in the settlement.

Lauren Horwood -- a spokesperson for the attorney's office -- said neither health system admitted wrongdoing as part of the settlement.

In a statement, CHW said it is "committed to ethical business practices and is pleased to have resolved this matter."

Sutter Health officials did not immediately comment, according to the Sacramento Bee (Smith, Sacramento Bee, 12/8).