ALLEGED MANIPULATION OF PATIENT DATA
Whistleblower Partners attorneys secured noteworthy settlements from Group Health Cooperative ($6.375 million) and Sutter Health ($90 million) on charges that the two organizations knowingly inflated the number and severity of patient diagnoses in order to increase risk scores and obtain Medicare Advantage payments to which they were not entitled. At the time, the Sutter Health Settlement was the largest Medicare Advantage False Claims Act (FCA) settlement against a hospital system, and the second largest reported Medicare Advantage fraud settlement ever. Now, Whistleblower Partners attorneys are pursuing similar charges against UnitedHealth Group and Kaiser Permanente, which are poised to be two of the largest intervened risk-adjustment cases in history.
