
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
Exploring ways to reduce the impact of space junk on Earth - 2
Curl Up With Some Hot Chocolate And Watch Mighty Car Mods Explore Japan In A Honda City Turbo II - 3
Voting begins in Uganda’s presidential election during internet shutdown and polling station delays - 4
The capacity to understand people on a profound level: Exploring Life's Intricacies - 5
Pick Your #1 breakfast food
Vote in favor of your Number one Kind of Gems
The Best 20 Tunes that Characterized an Age
Track down the Ideal Weight reduction Methodology for Your Way of life
Are multiverses real? An astrophysicist explains why it depends on how you define ‘real’
Why this Tennessee special election has the 'whole world' watching
Violence 'never part' of break-in plan, court told
I thought I knew the night sky, but what I saw from the Canary Islands left me speechless
How to get tickets for AC/DC's 2026 'Power Up' Tour
Triumph's 400 Range Has Just Changed In India, And Here's Why












