Sutter Hospital, a large hospital chain in Northern California, has had a qui tam lawsuit filed against them for false billing of anesthesia services. It is believed that the fraudulent amount is in the hundreds of million of dollars. Some of the billing codes for the services or supplies that Sutter Hospitals used were previously paid. In some cases, an anesthesiologist was not present or anesthesia was not even used during the procedure. Additionally, the bills were often inflated to higher anesthesia costs. Rockville Recovery Associates Limited was hired by a private insurance company to do independent billing consultation and review bills for fraudulent activity. They discovered Sutter Hospital’s fraudulent scheme and filed the suit against them. Recent reports have shown that Sutter’s fraudulent scheme has resulted in Northern California’s revenue per patient per day being 56% higher than Southern California. Sutter Hospital accounts for over a third of the hospital revenue.
For more information see: http://www.insurance.ca.gov/0400-news/0100-press-releases/2011/release053-11.cfm