United States of America v. Sutter Health

I. BACKGROUND

1 A. Factual Background 2 Relator filed this qui tam action against Sutter Defendants, Doctor Defendants, and 3 unknown Does 1–10 (collectively, “Defendants”). Relator alleges that Defendants’ “fraudulent 4 billing practices” violated the False Claims Act (“FCA”), 31 U.S.C. §§ 3729–33, and the 5 California False Claims Act (“CFCA”), Cal. Gov’t Code §§ 12650–56. FAC ¶ 2, ECF No. 13. 6 Specifically, Relator alleges that “through her expert analysis of thousands of adjudicated 7 Medicare claims,” she has “showed that Sutter [Health] and its surgeons freely took advantage of a 8 flawed medical payment system by regularly upcoding and unbundling major surgical codes for 9 breast cancer surgery, and coding ‘first-time’ immediate mastectomy reconstruction codes multiple 10 times in the same patient.” Id.; see FAC ¶¶ 4 (similar allegation against all Defendants), 22 11 (defining Defendant Sutter Health as “Sutter”). 12 To obtain the Medicare claims she analyzed, Relator made two Freedom of Information 13 Act (“FOIA”) requests to the Centers for Medicare & Medicaid Services (“CMS”). The first FOIA 14 request was made “in or about November 2016” and sought “billing and…