Shooters Are Going’ To Shoot and Cheaters Are Goin’ To Cheat

Imagine if you create a stupid grading system and you pay hospital systems more for those at higher risk. How many of you think some of those hospital system would “fudge” those numbers to get paid more? Well, here is one example:

Sutter Health agreed to pay $30 million to settle allegations that the Sacramento, Calif.-based health system submitted inflated diagnosis codes to the CMS for Medicare Advantage beneficiaries, the Justice Department announced Friday. 

The CMS pays private insurers a set amount per person to administer program benefits under Advantage plans and adjusts the payments based on “risk scores,” calculated using demographic information and health status data. Sutter and its affiliates contracted with certain Medicare Advantage organizations and received a share of the reimbursement for the beneficiaries under Sutter’s care.

But, hey, it’s only $30 million. That’s not as nearly criminal as a making 99213 to a 99214. That’s because you have no money to pay big lawyers to protect you. Not like these guys:

Neither Sutter nor its affiliated medical foundations admit any liability, the Justice Department noted in its news release.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

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