As Published By
ALAN S. RIPKA, ESQUIRE
Healthcare Provider Alleged Misconduct
The California state insurance Commissioner Dave Jones alleged earlier this week that Sutter Health, one of California’s largest health care givers, routinely and fraudulently charged insurers up to hundreds of millions of dollars over the past decade for anesthesia services that were not provided, and also double-billed for services performed. If Sutter Health fraudulently charged consumers, these persons should be reimbursed for the fraudulent charges, and any increase in premiums that can be attributed to the fraud, says Alan Ripka, Esquire.
The Commissioner will join a lawsuit filed two years ago by Rockville Recovery Associates, a firm that audited Sutter Home. The auditing firm claims that it firms found evidence of the frauds in a routine audit for an insurance company. Further analysis by the firm found similar practices at other Sutter Health locations, according to the lawsuit. Fraudulent charges by health providers such as those alleged by the Commissioner cause consumers and businesses to pay higher premiums that they should be charged.
Sutter Health officials deny the allegations and stated it plans to vigorously defend the charges. Sutter Health is a Sacramento-based health care provider with 24 hospitals and 3,500 doctors in its network. It operates as a nonprofit, and reported $9.1 billion in revenues in 2010. Sutter’s total income in 2010 was $878 million.
Anesthesiologists are usually not employed by hospitals and they typically bill insurers separately. The lawsuit alleges that Sutter hospitals routinely billed insurers for anesthesia services when patients were treated in an operating room, even when the anesthesiologist had already charged his or her own fee, and sometimes when no anesthesia had been used. Additionally, the lawsuit alleges that Sutter hospitals were charging up to $5000 for anesthesia, when the typical anesthesia bill is no more than $250.
This is not the first time Sutter Health has been scrutinized for overcharging practices. In 2006, Sutter Health agreed to provide discounts and refunds to uninsured patients it was accused of overcharging, stemming from a 2004 class action lawsuit.
According to the Commissioner, Sutter and intermediary Multiplan put provisions into its contracts preventing insurers from refusing to pay bills even if the insurers thought they were being wrongly charged. Sutter argues that the terms of the contract were negotiated between sophisticated parties, and thus the charges cannot be labeled “fraudulent” after the fact.
If you or that of a loved one feels that you may have been overcharged and/or double-billed by a health care provider for anesthesia services, you may be entitled to compensation. Alan Ripka and his professional team of lawyers can evaluate your situation and determine the next steps to gain justice for you and your family. Alan Ripka has fought against all kinds of companies in other matters and will fight for you if we believe you have a potential case for medical malpractice, products liability, or personal injury. I am prepared to go to court and have a trial if necessary. Please fill out the form and submit or call and ask for me, Alan Ripka. Please specifically mention that you read the blog when contacting me.