
By Jonathan Stempel
Jan 14 (Reuters) - The U.S. Department of Justice said five Kaiser Permanente affiliates in California and Colorado agreed to pay $556 million to resolve claims they illegally pressured doctors to add codes for diagnoses they never considered to patients' medical records, in order to inflate Medicare payments from the government.
Wednesday's settlement resolves two whistleblower lawsuits accusing the affiliates of Oakland, California-based Kaiser of violating the federal False Claims Act.
Kaiser did not immediately respond to requests for comment. The affiliates included Kaiser Foundation Health Plan, Kaiser Foundation Health Plan of Colorado, Colorado Permanente Medical Group, Permanente Medical Group, and Southern California Permanente Medical Group.
Under Medicare Advantage, also known as Medicare Part C, patients who opt out of traditional Medicare may enroll in private health plans known as Medicare Advantage Organizations, or MAOs.
The Justice Department said requiring diagnosis codes helps ensure that the Centers for Medicare & Medicaid Services pays MAOs such as Kaiser's more money for sicker patients.
Kaiser's alleged improper activity included having doctors "mine" patients' medical histories for potential diagnoses to add to medical records, and linking bonuses to meeting diagnosis goals. The alleged wrongdoing occurred between 2009 and 2018.
“Fraud on Medicare costs the public billions annually, so when a health plan knowingly submits false information to obtain higher payments, everyone - from beneficiaries to taxpayers - loses," Craig Missakian, the U.S. Attorney for the Northern District of California, said in a statement.
The settlement resolves claims by former Kaiser employees Ronda Osinek, a medical coder, and James Taylor, a doctor who oversaw risk adjustment programs and coding governance.
They will receive about $95 million from the settlement, the Justice Department said.
The False Claims Act lets whistleblowers sue on behalf of the government, and share in recoveries.
(Reporting by Jonathan Stempel in New York; Editing by Matthew Lewis)
LATEST POSTS
- 1
37 Things Just Individuals Experiencing childhood during the 80s Will Comprehend - 2
The next frontier in space is closer than you think – welcome to the world of very low Earth orbit satellites - 3
Journalist reported killed in the Gaza Strip - 4
Guns N' Roses 2026 Tour: How to get tickets, presale times, prices and more - 5
From invasive species tracking to water security – what’s lost with federal funding cuts at US Climate Adaptation Science Centers
Tesla plans to expand production at German car plant
Flash flooding causes highways to close to and from Eilat
The 15 Most Rousing TED Chats on Self-awareness
Sophie Kinsella, 'Confessions of a Shopaholic' author, dies at 55 after battle with cancer
Manual for Famous Beverages 2024
L.A.'s most famous midcentury home, the Stahl House, is on the market for the 1st time, at $11K per square foot: See inside
41 Young Men Die in South Africa After Circumcision Initiation
Vehicle Lovers' Decision: Purchase A Reasonable Vehicle
Manual for Tracking down the Nearby Business sectors and Marketplaces













