More details revealed as allegations unfold of Stanford Hospitals unlawfully charging Northern California patients and falsifying their records. The case is captioned United States vs. Stanford et al. Case No. CV 17-08726-DSF (AFMx). It is a live case in the Central District Federal Court.
The Department of Justice also just filed in Federal Court a “Statement of Interest” in support of the false claims action (“FCA”) against Stanford Health Care (formerly Stanford Hospitals and Clinics).
The Complaint alleges that Stanford is a purported non-profit organization that has been exempt from paying taxes with the sole intent of offering the best service to the residents of Northern California. The complaint further alleges, Stanford habitually and schematically defrauded its patients under the guise of false surgical billing.
The recently unsealed lawsuit in Federal Court (unsealed from July 30, 2019 onward) alleges that Medicare and Anthem Blue Cross claims analysis revealed that Stanford and its surgeons purposely take advantage of a flawed medical payment system by habitually upcoding and unbundling major surgical codes for breast cancer surgery, and also unbundling and charging excessive fees for otherwise "free" services, considered part of the global surgery fees.
The Complaint alleges that Stanford billing schemes and submission of fraudulent or misleading healthcare bills to government and private insurers demonstrate that Stanford is purposely extorting the public, especially women that come to Stanford to get breast cancer treatment.
In addition, the lawsuit further alleges Stanford Healthcare is too expensive and unaffordable for many patients particularly for women's health and mastectomy surgery and this led to a situation whereby top insurance providers are terminating their contracts with Stanford. The proof herein lies when major commercial insurance carriers like Anthem Blue Cross, and earlier Blue Shield unilaterally terminated contracts with Stanford.
Furthermore, the Complaint also alleges that when visiting Stanford, patients are unlawfully billed for unsupervised and unlicensed practice of medicine, and diagnostic testing and procedures by unlicensed personnel. Stanford is alleged to sternly instruct their medical billers and coders to always charge higher bills and at maximum level for similar procedures. To cover this fraud, the Complaint alleges that Stanford intentionally lacks transparency and its billing ledgers are not understandable.
Ms. Juarez specializes in false claims acts and represents the Relator in this case. Former or Current Stanford billing and coding employees wishing to obtain more information on this False Claims Act case or discuss new information and allegations may contact Ms. Juarez's office.