California insurance commissioner joins Sutter Health whistleblower suit

California Insurance Commissioner Dave Jones has joined a whistleblower lawsuit against Sutter Health claiming the Sacramento-based hospital operator routinely submitted false bills for anesthesia services, report the Sacramento Bee and the San Francisco Chronicle.

Jones, a Democrat who was elected commissioner last November, joined a lawsuit filed against Sutter in 2009 by healthcare recovery auditor Rockville Recovery Associates, which audited Sutter at the request of Guardian Life Insurance of America.

Typically, hospitals charge a relatively nominal fee for anesthesia services, primarily to cover the cost of a technician to prepare the operating room. But Sutter allegedly charges up to $5,000 for such services, even when an anesthesiologist charged a separate fee. In some instances, it's been alleged Sutter charged the fee even if no anesthesia was used in a procedure.

"We believe the amount of the fraudulent charges is in the hundreds of millions of dollars, if not more," said Jones, who used his authority under the California Insurance Frauds Prevention Act to intervene.

Sutter issued a statement denying the allegations and said it plans to "vigorously defend this matter."

For more:
- read the Sacramento Bee article
- read the San Francisco Chronicle article

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.