Calif.-Based Sutter Health Agrees To $30M Settlement Over Allegations Of Submitting Inflated Diagnosis Codes To CMS

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The Department of Justice alleges that Sutter and its affiliates submitted diagnosis codes that inflated the risk scores for certain beneficiaries in their care. “With some one-third of people in Medicare now enrolled in managed care…plans, large health care systems such as Sutter can expect a thorough investigation of claimed enrollees’ health status,” said Steven J. Ryan, special agent in charge with the Office of Inspector General for the U.S. Department of Health and Human Services.