Inactive Case

United States ex rel. Ormsby v. Sutter Health et al.

Docket No.
3:15-cv-01062
District Court
California Northern

Goal

  • Award damages
  • Block defendant action

Issues

Why This Matters:

Why This Matters:

The Department of Justice joined a whistleblower lawsuit against a nonprofit health system in California, alleging that the health system systematically submitted inaccurate, incomplete, unsupported, or otherwise false diagnosis codes for Medicare Advantage enrollees. The whistleblower and Department of Justice allege that the health system submitted this false information – also known as upcoding – to improperly obtain millions of dollars in overpayments from the Medicare program.

Potential Impact:

Impact:

In 2021, the parties entered into a settlement where the health system agreed to pay $90 million to resolve these allegations and to implement other corrective measures. Ensuring accurate compensation for Medicare Advantage organizations prevents fraud, protects taxpayer dollars, and keeps health care costs low for patients.

22 Major Filings

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Related Litigation

Current Status

Case Dismissed

Legal Issues

False Claims Act

Date Filed
March 6, 2015
Case Type
Civil
Court Type
District Court
Court
California Northern
Judge
Beeler, Laurel
Plaintiff(s)
Kathy Ormsby
Lead Counsel For Plaintiff(s)
Keller Grover LLP
Intervenor Plaintiff(s)
United States
Defendant(s)
Sutter Health; Palo Alto Medical Foundation
Lead Counsel for Defendant(s)
Latham & Watkins LLP