United States of America v. Sutter Health

I. BACKGROUND

1 A. Factual Background 2 Relator “is a physician and surgeon, and a certified professional medical coder, who has 3 worked in a surgical specialty from 2000 to the present.” ECF No. 96 (“SAC”) ¶ 41. On 4 November 15, 2012, Relator was diagnosed as having a high risk for potential breast cancer by Dr. 5 Roy Hong, who worked for Sutter Health and Palo Alto Medical Foundation. Id. ¶ 42. On 6 December 12, 2012, Relator underwent an operation for a single-stage breast reconstruction by Dr. 7 Hong at Palo Alto Medical Foundation. Id. ¶¶ 3, 43. Relator’s single-stage breast reconstruction 8 “follow[ed] [a] preventative double mastectomy by a non-Sutter surgeon Dr. Frederick Dirbas.” 9 Id. ¶ 3. 10 Relator alleges that, on or about December 11, 2012, Relator “spoke alone directly with 11 Dr. Hong, who later admitted to her that he, [Palo Alto Medical Foundation] and Sutter [Health] 12 had falsely represented to her insurance carrier that she had been diagnosed with breast cancer, 13 when in fact she did not have breast cancer.” Id. ¶ 46. “Moreover, he admitted that he performed 14 these same breast reconstructive procedures frequently on all his clients, specifically…