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Sutter Health to pay $30M to settle upcoding allegations
Modern Healthcare: 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.
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