
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
Kids get diseases like lupus, too. As researchers hunt better treatments, this camp brings joy - 2
Canada's Friendly Sunshine Coast City Is An Outdoor Playground Perfect For Hiking And Paddling - 3
Elite Execution Wall televisions for Film Darlings - 4
CVS forecasts 2026 profit above estimates on strong performance - 5
How grandchildren are stepping up to fill the caregiver gap
Australian State Triggers Emergency Powers Amid Fuel Crisis
Step by step instructions to Buy a Jeep Wrangler on a Senior's Spending plan
Eurovision Song Contest changes voting rules after controversial allegations against Israel
Can scientists detect life without knowing what it looks like? Research using machine learning offers a new way
Flourishing in Retirement: Individual Accounts of Post-Profession Satisfaction
Protest inspired by 'Gen Z' movement draws few young people in Mexico and many government critics
Iranian missile hit on Ne'ot Hovav factory leads to fear of chemical leakage
Vote in favor of your #1 Kind of Cap
Simple Consideration Plants for Home and Office: An Aide












