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    Sutter Health Plus’ Suspected Fraud and Abuse Reporting

    Sutter Health Plus’ compliance program integrates ethical, legal and regulatory guidance to foster an environment in which members are empowered and encouraged to ask questions and report concerns.

    The Sutter Health Plus anti-fraud program serves to prevent, detect and correct instances of fraud, thereby reducing costs to members and others caused by fraudulent activities. The anti-fraud program also serves to protect consumers in the delivery of health care services through the timely detection, investigation, and prosecution of suspected fraud in accordance with Section 1348 of the Knox-Keene Act, and applicable federal and state regulations.

    There are many examples of fraud and abuse which include:

    • Billing for services or items that were not provided
    • Billing for services or equipment that are more expensive than what was supplied
    • Members allowing someone else to use their SHP ID card
    • A provider paying a member to obtain care or services
    • Identity theft
    • Falsifying medical records


    Report Suspected Fraud and Abuse
    If you would like to speak with someone directly, please contact Sutter Health Plus Member Services at
    855-315-5800 or email us at shpcompliance@sutterhealth.org

    If sending an email please include the following information:
    • Date suspected fraud occurred
    • Date suspected fraud was discovered
    • Where the suspected fraud occurred
    • Provide a description of the incident or suspected fraud
    • List all persons engaged in this suspected fraud
    • How you become aware of this
    • List any individuals who have attempted to conceal the issue, and the steps they took to conceal it