DOJ Addicted To Failed FCA Theory, Hospital Chain Says

Law360 (June 17, 2019, 7:30 PM EDT) -- The U.S. Department of Justice is clinging to a discredited False Claims Act theory that improperly imposes stricter billing standards in privately run Medicare Advantage than traditional government-run Medicare, California hospital chain Sutter Health said Friday.

In a motion to dismiss, Sutter and its Palo Alto Medical Foundation affiliate knocked the government for pursuing a whistleblower manager's FCA case that targets billing for unsupported diagnoses of Medicare Advantage beneficiaries. The case echoes failed attempts by the government to punish unsupported billing by Medicare Advantage insurers even though the government doesn't punish equivalent rates of unsupported billing in traditional Medicare, Friday's motion...

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Attached Documents



Case Information

Case Title

Subscribers Only

Case Number

Subscribers Only


California Northern

Nature of Suit

Other Statutes: False Claims Act


Subscribers Only

Date Filed

March 6, 2015

Law Firms


Government Agencies